Pediatric RN- Quality Practice Advisor

You could be the one who changes everything for our 28 million members. reputed company is transforming the health of our communities, one person at a time. As a reputed company, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

• ***NOTE: This is a work-from-home, hybrid remote (up to 50% travel) role that meets virtually and in person with provider groups based in South Carolina to discuss and improve HEDIS performance. Typical daily tasks will include creating/using PowerPoint presentations, creating/exporting reports, and data analysis. Preference will be given to applicants who (1) reputed company in South Carolina, (2) have a pediatric background, and (3) an active RN license.

Additional Details:

• Department: MED-Quality Improvement
• Business Unit: Absolute Total Care
• Schedule: Mon – Fri, reputed company – 5 pm CT
• Territory: Typically no more than 2 hours from residence.****

Position Purpose: Establishes and fosters a healthy working relationship between large physician practices, reputed company and reputed company. Educates providers and supports provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment. Provides education for HEDIS measures, appropriate medical record documentation and appropriate coding. Assists in resolving deficiencies impacting plan compliance to meet State and Federal standards for HEDIS and documentation standards. Acts as a resource for the health plan peers on HEDIS measures, appropriate medical record documentation and appropriate coding. Supports the development and implementation of quality improvement interventions and audits in relation to plan providers.

• Delivers, advises and educates provider practices and reputed company in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with state, federal, and NCQA requirements.
• Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data to identify and strategize/coach on opportunities for provider improvement and gap closure.
• Collaborates with Provider Relations and other provider facing teams to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters).
• Identifies specific practice needs where reputed company can provide support.
• Develops, enhances and maintains provider clinical relationship across product lines.
• Maintains Quality KPI and maintains good standing with HEDIS Abstraction accuracy rates as per corporate standards.
• Ability to travel up to 75% of time to provider offices.
• Performs other duties as assigned.
• Complies with reputed company policies and standards.

Education/Experience: Bachelor's Degree or equivalent required 3+ years in HEDIS record collection and risk adjustment (coding) required Licenses/Certifications: One of the following required: reputed company, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A or reputed company Registered Health Information Technician (RHIT®) Pay Range: $26.50 - $47.59 per hour reputed company offers a comprehensive benefits package including: reputed company, health insurance, 401K and stock purchase plans, tuition reimbursement, paid 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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. 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 regard 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 Act Apply tot his job Apply To this Job