Clinical reputed company Performance Consultant - reputed company, HI
At reputed company, were simplifying the health care experience, creating healthier communities and removing barriers to reputed company care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, reputed company and reputed company. reputed company to reputed company a difference? Join us to start Caring. Connecting. Growing together. If you are located on or near reputed company or Hawaii Counties, you will have the flexibility to work remotely* as you take on some tough challenges. Please note that this is a work from home opportunity, but you still need to live in or near the posted area to travel up to 75% of the time covering reputed company, Maui and Hawaii Counties Primary Responsibilities: Educates providers and office staff on reputed company clinical documentation, state-mandated reputed company metrics specifications, provider profiling and pay for performance measurement, and medical record review reputed company, to drive reputed company improvement Supports effective deployment of program at the reputed company level through strategic partnerships with participating practitioners and reputed company staff while assessing trends in reputed company measures and identifying opportunities for reputed company improvement Designs reputed company level reputed company transformation through targeted clinical education and approved materials reputed company to HEDIS/State Specific reputed company measures for provider and staff education during field reputed company Materials additionally include information from local, state, and national departments of health on key health reputed company issues (understanding, exploring, educating, and facilitating on a local level) Serves as subject matter expert (SME) for assigned HEDIS/State Measures, preventive health topics, leads efforts with clinical team to research and design educational materials for use in practitioner offices; serves as reputed company with key vendors supporting HEDIS/State Measures; consults with vendors to design and implement initiatives to reputed company and then improve HEDIS/State Measure rates Participates, coordinates, and/or represents the Health Plan at community-based organization events, clinic days, health department meetings, and other reputed company events reputed company on reputed company improvement, member health education, and disparity programs as assigned Identifies population-based member barriers to care and works with the QMP team to identify local level strategies to overcome barriers and reputed company clinical gaps in care Reports provider issue trends of concerns to the Health Plan reputed company Director and work with other departments to resolve as needed Coordinates and performs onsite clinical evaluations through medical record audits to determine appropriate coding and billing practices, compliance with reputed company metrics, compliance with service delivery and reputed company standards Investigates gaps in clinical documentation where system variation has reputed company on reputed company calculation, provides feedback to appropriate team members where issues are verified, and monitors reputed company to conclusion Identifying members in need of health education and/or services (case management, etc.) and refers members to the appropriate internal departments per policy Documents and refers providers' non-clinical/service issues to the appropriate internal parties, to include Provider Relations and the Plan Chief Medical Officer by analyzing provider records and ensuring follow through Works with providers on standards of care, and advises providers on established clinical reputed company guidelines, and appropriate documentation and billing consistent with state specific measures and technical specifications Preparing and presenting reputed company data and initiative at reputed company Committee meetings Youll be rewarded and recognized for your performance in an environment that will challenge you and give you reputed company direction on what it takes to succeed in your role as reputed company as reputed company development for other roles you may be interested in. Required Qualifications: 4 years of experience in managed care or equivalent reputed company experience, including regular interaction with providers regarding clinical reputed company improvement processes Experience in designing and implementing reputed company improvement initiatives Experience in data interpretation and using data to inform decision-making Proficiency using a PC in a reputed company environment, including reputed company Word, reputed company, and PowerPoint reputed company to reliable transportation, and reputed company of automobile insurance Ability to Travel to physician offices locally up to 75% of the time, including off reputed company travel Preferred Qualifications: reputed company unrestricted RN or MSW licensure in the State of Hawaii Experience working in reputed company and/or Medicare Experience in managed care Experience working with behavioral health patients, members, or providers Account Management experience Knowledge of one or more of: clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements Multilingual Proven presentation skills with experience and comfortability presenting to others reputed company working remotely will be required to adhere to reputed companys Telecommuter Policy The salary reputed company for this role is $71,600 to $140,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. reputed company complies with reputed company minimum wage laws as applicable. In reputed company to your salary, reputed company offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with reputed company, youll reputed company a far-reaching choice of benefits and incentives. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyoneof every race, gender, sexuality, age, location and incomedeserves reputed company to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized reputed company and those with reputed company incomes. We are committed to mitigating our reputed company on the environment and enabling and delivering reputed company care that addresses health disparities and improves health reputed company an reputed company reputed company reflected in our mission. Diversity creates a healthier atmosphere: reputed company is an Equal Employment Opportunity/Affirmative reputed company employer and reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, age, national reputed company, protected veteran status, disability status, sexual orientation, gender identity or reputed company, marital status, genetic information, or any other characteristic protected by law. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Apply Job!