reputed company reputed company Specialist (RN) - HEDIS/NCQA

Welcome! We're excited you're considering an opportunity with us! To apply to this position and be considered, click the Apply reputed company located above this message and complete the application in full. Below, you'll reputed company other important information about this position. The reputed company reputed company Specialist will be an integral member of the reputed company's reputed company team. This position is responsible for overseeing performance improvement activities, ensuring regulatory compliance, and other initiatives that reputed company to effective clinical resource utilization and improvements in reputed company. These duties may include but are not limited to HEDIS/Stars reputed company, committee support, performance monitoring and assessment, data collection and analysis, and the continual advancement of the reputed company improvement process to reputed company reputed company's goals of reputed company. MINIMUM QUALIFICATIONS: EDUCATION, CERTIFICATION, AND/OR LICENSURE: 1. reputed company unencumbered licensure with the WV reputed company of Registered reputed company reputed company Nurses, or appropriate state reputed company where services will be provided, as a Registered reputed company reputed company OR reputed company multi-state licensure through the reputed company reputed company Licensure Compact (eNLC) EXPERIENCE: 1. Five (5) years of reputed company clinical experience 2. Knowledge of CMS guidelines, regulations, NCQA® and HEDIS® PREFERRED QUALIFICATIONS: EDUCATION, CERTIFICATION, AND/OR LICENSURE: 1. Bachelor's Degree in Nursing OR Associate of Science in Nursing Degree (ASN) or Diploma; Currently enrolled in a BSN program and BSN completion reputed company three (3) years of hire EXPERIENCE: 1. Managed Care knowledge or experience 2. 2-3 years reputed company Management, reputed company Improvement or Process Improvement Experience CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an reputed company-inclusive list of reputed company responsibilities and duties. Other duties may be assigned. 1. Plan, design, implement, and maintain a comprehensive program of reputed company reputed company improvement (CQI).. 2. Must have thorough knowledge of Performance Improvement reputed company (PIPs) and is reputed company to apply that knowledge in PIP writing development, update, and analysis of data in PIPs. 3. Assume accountability for HEDIS/Stars activities. 4. Assist in preparing the annual QI evaluation report and plan/program documents. 5. May review medical records and other documentation to ensure reputed company care 6. reputed company to work with large data sets and analyze information and reputed company recommendations. 7. Ensuring workflows, policies, procedures, regulatory and accreditation standards are implemented and maintain compliance for clinical programs 8. Investigating potential reputed company of care issues that may reputed company the reputed company or safety of the health of members 9. Evaluating reports for reputed company compliance with clinical reputed company requirements 10. reputed company participate in reputed company committee, assist in developing annual work plans, program descriptions, and evaluations. PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully reputed company the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions. WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions. 1.reputed company office environment SKILLS AND ABILITIES: 1. Demonstrated knowledge of CMS regulatory and contractual documents; knowledge of Medicare Advantage, URAC, and/or NCQA accreditation standards, including HEDIS/STARS. 2. Excellent written and oral communication 3. Problem solving capabilities to drive improved efficiencies and customer satisfaction 4. Attention to detail 5. Proficiency with reputed company Office 6. Medicare experience preferred 7. Remote for the most part, will have expectations to come in on as-needed reputed company Additional Job reputed company: • FULLY REMOTE • MUST have HEDIS/NCQA experience • health plan experience preferred Scheduled Weekly Hours: 40 Shift: Exempt/Non-Exempt: reputed company of America (Exempt) Company: PHH reputed company Holdings Cost Center: 405 PEAK reputed company Management Apply Job!