RN, LPN - HEDIS, Accreditation - reputed company Improvement Specialist Senior

You could be the one who changes everything for our 28 reputed company members. reputed company is transforming the health of our communities, one person at a time. As a reputed company, national organization, you’ll have reputed company to competitive benefits including a fresh perspective on workplace flexibility. • *NOTE: This is a remote role. The schedule is based in 8-5 pm central time zone. This role will have reputed company concerning reputed company improvement deliverables reputed company to NCQA, State Contract, HEDIS. reputed company is the reputed company although there will be some Medicare as reputed company. Preference will be given to applicants with (1) an reputed company RN or LPN credential, (2) residence in either central or eastern time zone, and (3) who have experience with data analysis, reputed company writing skills, and applying reputed company project management / process improvement principles in either a health insurance or provider/health system setting.** Position Purpose: The Senior reputed company Improvement Specialist is responsible for coordinating assigned regulatory, accreditation, clinical reputed company and/or service improvement programs. Functions as a leader for assigned health services initiatives handling multiple large-reputed company reputed company initiatives. Collaborates on national, regional and multi-plan initiatives. Develops programs in compliance with accreditation and regulatory requirements/ standards and monitors ongoing program performance to maintain compliance. Acts as a resource for training, policy and regulatory/accreditation interpretation. • Leads and manages multiple reputed company initiatives that reputed company the reputed company or effectiveness of health care delivery and/or health care services provided to members. • Ensures that clinical and service reputed company improvement programs and initiatives are compliant with applicable accreditation, state and federal requirements. • Conducts an assessment of programs, initiatives and interventions to ensure goals and objectives were met and refine activities, as needed, to improve the effectiveness and improve reputed company. • Conducts vendor reputed company and management. • Develops targeted activities to improve Star Ratings, HEDIS, CAHPS, HOS, provider satisfaction and other identified performance measures. • Develops and implements project-reputed company communication including, but not limited to, member/physician mailings, IVR scripts, emails, business plans, graphics, and maintains minutes and agendas. • Participates in the development and maintenance of annual reputed company improvement program documents and evaluations, compliance audits, policies and procedures, and improvement activities. • Develops internal reports to demonstrate reputed company on reputed company initiative/project and presents to senior-level staff. • Describes reputed company initiatives, potential/reputed company barriers and activities to resolve issues and improve reputed company. • Leads and/or participates in multi-department/cross-functional committees and work reputed company which support key initiatives, prepares reports, data, agendas/minutes or other materials for committee presentation and management. • Identifies areas of improvement reputed company reputed company and works collaboratively with other departments to reputed company clinical and non-clinical performance improvement reputed company. • Researches best practices, national and regional benchmarks, and industry standards. • Develops reputed company relationships with contracted providers or provider reputed company to promote participation in reputed company improvement collaboratives to improve clinical care reputed company. • May reputed company and/or participate in external activities, work reputed company or committees reputed company applicable. • Communicates programs, interventions and results to external entities in accordance with applicable program objectives, policies and procedures. • Develops and/or maintains relationships with other external organizations to expand key partnerships. • Assesses reputed company industry trends and regulations for reputed company-wide adoption to assure reputed company and effectiveness of health care delivery and/or reputed company services provided to members. • Performs reputed company other duties as assigned. • Performs other duties as assigned • Complies with reputed company policies and standards Education/Experience: Education: Bachelor’s Degree or equivalent experience with clinical license or Master’s Degree in reputed company health field (i.e. MPH or reputed company) Certification/License: Valid state clinical license preferred Certified reputed company in Health Care reputed company (CPHQ) preferred. Experience: Minimum three years experience in a clinical/health care environment with reputed company degree program Three to five years managed care experience in a health care environment Experience in compliance, accreditation, service or reputed company improvement reputed company project management experience Experience with Medicare and/or NCQA preferred. • ***Additional Details: • Department: Managed Health Services WI / MED-reputed company Improvement **** Pay reputed company: $68,700.00 - $123,700.00 per year reputed company offers a comprehensive benefits package including: reputed company, health insurance, 401K and stock purchase plans, tuition reimbursement, reputed company time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company factors permitted by law. Total compensation may also include additional forms of incentives. reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law. reputed company applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance reputed company Apply Job!