Senior Clinical Quality RN - Hybrid
About The Position
Hybrid role working in the office/field 3 days a week and remote/home 2 days a week and which is contingent upon the business needs. This does require travel in the field to provide offices approximately 35%25 of time in rural & outlier areas. For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. The Sr. Clinical Quality Consultant RN will drive consistency, efficient processes and share best practices, in a collaborative effort with the provider and large or complex groups, designed to facilitate a minimum 4 STAR quality performance. The Sr CQC will participate in quality improvement initiatives, attend monthly or joint operating committee meetings, develop recommendations for quality remediation plans and create tools and databases to capture relevant data for each region. This position will work collaboratively with each regional/market team and their leadership in a matrix relationship. This position may serve as the team lead for the clinical quality consultants in the assigned market and has responsibility for the network’s quality performance. This position follows a hybrid schedule with three in-office days per week.
Requirements
- Current unrestricted Registered Nurse Nevada license
- BLS Required
- 4+ years of healthcare experience, including experience in a managed care setting
- 2+ years of experience in provider facing interactions, including provider education
- 2+ years of experience with data analysis and/or quality chart reviews. Ability to review data and provide recommendations for improvement
- Ability to travel 35%25 locally with occasional overnight travel
Nice To Haves
- Undergraduate degree, postgraduate degree
- 2+ years of experience in HEDIS/Star programs, preferably in a clinical quality consultant role
- Billing and CPT coding experience
- Clinical data abstraction experience
- Experienced using Microsoft office applications, including databases, word-processing, and excel spreadsheets. Proficient in Excel
- Medicare experience
Responsibilities
- Develop market business plans to motivate providers and large or complex group leadership to engage in improving Stars measures to be 4 STARS or higher
- Provide analytical interpretation of Stars and HEDIS reporting, including executive summaries to plan and provider groups
- Be the primary subject matter expert for all STARS-related activities within their assigned market(s) working within a matrix relationship which includes Quality corporate operations and Regional/Market operations
- Lead or participate and present in weekly, Monthly, Bi-monthly, Quarterly and/or Annual business Review meetings related to STAR activities which summarize provider and large group performance and market performance as requested by or required by Quality or Regional leadership
- Analyze and evaluate provider and large group structure and characteristics, provider group/provider office operations and personnel to identify the most effective approaches and strategies
- Assist in developing training and analytical materials for Stars and HEDIS
Benefits
- a comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
