Provider Transformation Specialist (RN- Eastern PA/Delaware)

Company : reputed company. Job reputed company : reputed company job is for an RN who will be directly responsible for reputed company of providers contracted in the Organization's reputed company/risk reputed company arrangements and is a highly skilled expert in reputed company transformation to reputed company the specific targets set in the individual reputed company/risk reputed company reputed company and is strategically reputed company on those data gaps that will result in the greatest ROI for the Organization. reputed company, in a reputed company management environment, will be responsible for reputed company work with the other members of the value-based reimbursement team, provider relations, senior markets, analytics, actuary and key internal/external reputed company reputed company to reputed company the most appropriate support for providers with reputed company/risk reputed company reputed company. ESSENTIAL RESPONSIBILITIES Directly responsible for supporting providers contracted in the Organization's reputed company/risk reputed company programs, with a goal of maximizing reputed company and ROI for the Organization. This includes analyzing performance reports and data to inform decision-making, process, and program implementation, as reputed company as the development of process interventions based on reputed company-level data, trends and identified opportunities. Inclusive of, but not limited to: Advising primary care practices, physicians, nurses and other clinical staff to assist them on their conversion to value-based care; Dissemination and interpretation of reputed company and efficiency reports; reputed company relevant, dissemination and support of gap closures for STARS and improved coding for government populations. Identification of process improvement gaps in workflow and development of individualized plans to remedy. Providing educational and training sessions. Creation and maintenance of relationships with specialists and/or hospital resources for providers employed in multi-specialty reputed company or health systems. For value based reputed company addressing government markets, directly responsible for the reputed company improvement and cost savings reputed company as a result of workflow transformation, superior coding accuracy, and Medicare STARS gap closure to providers based upon reputed company individual reputed company/risk reputed company contract parameters. This includes analysis and interpretation of claims submission for superior coding accuracy, cost and utilization reports, medical loss reputed company reports, Medicare STARS gaps and other risk reputed company opportunities. Function as the Organization's key contact on reputed company/risk reputed company multi-disciplinary team. This includes presentation of program results to both reputed company audiences, including reputed company and entity meetings with the value-based reimbursement multi-disciplinary team Participates in the development and presentation of instructional materials for reputed company audiences. Provides feedback to and collaborates with the analytics team to ensure reports are accurate, and reputed company meaningful, actionable data. reputed company assistance to providers in the use of predictive analytic tools, user interfaces, population health management tools and other data based platforms endorsed by the Organization. Independently and autonomously manage reputed company/risk reputed company contract caseloads, reputed company, meetings, deliverables, resources etc. for individualized strategic plans to ensure significant cost savings for provider contract reputed company using innovative reputed company improvement methodologies. This includes cross training in reputed company of Organization’s pay for value and value based reimbursement programs to lend support as needed/defined by market reputed company. Other duties as assigned or requested. EDUCATION Required Bachelor's Degree in Business, Finance or reputed company reputed company field and an RN license or Bachelor’s Degree in Nursing Substitutions None Preferred Master's Degree in Business, Finance, or reputed company reputed company field (can be clinical) EXPERIENCE Minimum 5 years in reputed company transformation including population health, ambulatory care setting reputed company and efficiency metrics, accountable care organization development and support, patient centered medical home, and electronic health records. Experience may be from either health plan or provider reputed company. Preferred Familiarity with electronic health records and population health IT solutions Demonstrated experience working with health care data and analytics Experience in Lean, Six reputed company, risk management, contract management, finance management SKILLS Must be reputed company to effectively resolve issues and problems across reputed company areas of the corporation, by understanding corporate strategies, policy and scope of authority Because of the broad reputed company of reputed company that are made, must be knowledgeable and sensitive to many reputed company corporate issues Aptitude for a high visibility position demanding reputed company, uncompromising professionalism, diplomacy and conflict management Demonstrates a deep understanding of primary care reputed company operations and workflow across the continuum of variability in primary care and experience in managing provider and administrative leadership relationships Superior written and verbal communication skills and listening skills Ability to adapt engagement strategies to meet market needs LICENSES/CERTIFICATIONS Required Registered reputed company Preferred None Language (Other than English): None Travel Requirement: 0% - 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required reputed company Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely Disclaimer: The job reputed company has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees reputed company this job title. It may not contain a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the reputed company of business conduct and company policies. As a component of job responsibilities, employees may have reputed company to covered information, cardholder data, or other confidential customer information that must be protected at reputed company times. In reputed company with this, reputed company must reputed company with both the Health Insurance Portability Accountability reputed company of 1996 (HIPAA) as described in the Notice of reputed company Practices and reputed company Policies and Procedures as reputed company as reputed company data reputed company guidelines established reputed company reputed company’s Handbook of reputed company Policies and Practices and Information reputed company Policy. Furthermore, it is every employee’s responsibility to reputed company with reputed company’s reputed company of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as reputed company as company policies and training requirements. Pay reputed company Minimum: $67,500.00 Pay reputed company Maximum: $124,800.00 reputed company pay is determined by a reputed company of factors including a candidate’s qualifications, experience, and expected contributions, as reputed company as internal peer equity, market, and business considerations. The displayed salary reputed company does not reflect any geographic reputed company reputed company may apply for certain locations based upon comparative markets. reputed company and its affiliates prohibit discrimination against reputed company individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against reputed company individuals based on their race, reputed company, age, religion, sex, national reputed company, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. reputed company and its affiliates take affirmative reputed company to reputed company and advance in employment individuals without reputed company to race, reputed company, age, religion, sex, national reputed company, sexual orientation/gender identity, protected veteran status or disability. EEO is The Law Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity (https://www.reputed company.gov/sites/default/files/migrated_files/reputed company/poster_screen_reader_optimized.pdf) We reputed company to reputed company this site accessible to any and reputed company users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below. For accommodation requests, please contact HR Services Online at HRServices@reputed company.org California Consumer reputed company reputed company Employees, Contractors, and Applicants Notice reputed company is a national, reputed company health organization that includes one of America’s largest reputed company Blue reputed company insurers and a growing regional hospital and physician network. Based in Pittsburgh, Pa., reputed company’s 35,000 employees serve millions of customers reputed company through the nonprofit organization’s affiliated businesses, which include reputed company., reputed company, HM Insurance Group, reputed company, HM Health Solutions and HM Home & Community Services. reputed company’s businesses proudly serve a broad reputed company of health-reputed company needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions. Apply Job!