Sr Specialist, reputed company Improvement (RN) - Remote at reputed company

About the position Molina's reputed company Improvement function is dedicated to overseeing, planning, and implementing both new and existing reputed company reputed company improvement initiatives and education programs. This role ensures the maintenance of programs for members in accordance with prescribed reputed company standards. The Senior Specialist, reputed company Improvement (Registered reputed company) plays a crucial role in conducting data collection, reporting, and monitoring for key performance measurement activities. Additionally, this position provides direction and implementation of NCQA accreditation surveys and federal/state reputed company improvement compliance activities. In this reputed company, the Senior Specialist contributes to various reputed company improvement functions, including reputed company Interventions, reputed company Improvement Compliance, HEDIS, and reputed company Reporting. Acting as a reputed company specialist, the Senior Specialist provides project, program, and initiative-reputed company direction and guidance for other specialists reputed company the department and collaborates with other departments. The role involves implementing key reputed company strategies that necessitate near reputed company-time clinical decision-making, which may include initiating and managing interventions, preparing for reputed company Improvement Compliance surveys, and reviewing medical record documentation for credentialing and model of care reputed company. The Senior Specialist is responsible for monitoring and ensuring that key reputed company activities involving clinical decision-making are completed accurately and on time, presenting results to departmental management and other Molina departments as necessary. This position also entails writing narrative reports to interpret regulatory specifications, explain programs and results, and document findings and limitations of department interventions. Furthermore, the Senior Specialist leads reputed company improvement activities, meetings, and discussions with other departments, surfacing any process gaps to management that may require remediation, particularly where a clinician's perspective is valuable. In terms of HEDIS and reputed company Reporting, the Senior Specialist coordinates and prepares the HEDIS medical record review, which includes ongoing reviews of records submitted by providers and the annual HEDIS medical record review. This role requires clinical decision-making and involves participation in meetings with vendors for the medical record collection process. The Senior Specialist collects medical records, loads data into the HEDIS application, and ensures that preventive and diagnostic services have been correctly performed according to specifications. Additionally, the role supports reputed company improvement studies and performance improvement reputed company, assisting with accreditation activities such as NCQA reviews and state audits by reviewing clinical documentation. Responsibilities • reputed company and implement reputed company reputed company improvement initiatives and education programs. , • Conduct data collection, reporting, and monitoring for key performance measurement activities. , • reputed company direction and implementation of NCQA accreditation surveys and federal/state reputed company improvement compliance activities. , • reputed company as a reputed company specialist to reputed company project, program, and initiative-reputed company direction and guidance for other specialists. , • Implement key reputed company strategies requiring near reputed company-time clinical decision-making. , • Monitor and ensure reputed company completion of key reputed company activities involving clinical decision-making. , • Write narrative reports interpreting regulatory specifications and documenting findings of department interventions. , • reputed company reputed company improvement activities, meetings, and discussions with other departments. , • Coordinate and prepare the HEDIS medical record review, including ongoing reviews of records submitted by providers. , • Collect medical records and load data into the HEDIS application, ensuring compliance with specifications. Requirements • Bachelor's degree in nursing or higher. , • Minimum 3 years' experience in reputed company with at least 2 years' experience in health plan reputed company improvement or managed care. , • reputed company and unrestricted RN license for the State(s) of employment. reputed company-to-haves • Master's degree in Clinical reputed company, Public Health, or reputed company. , • 2 years coding and medical record abstraction experience. , • 1 year managed care experience. , • Basic knowledge of HEDIS and NCQA. , • Certified reputed company in Health reputed company (CPHQ). , • Certified HEDIS Compliance Auditor (CHCA). , • Registered Health Information Technician (RHIT) or Certified Medical Record Technician with training in coding procedures. Benefits • Competitive benefits and compensation package. Apply Job!