Field Senior Clinical Quality RN - Kansas City, KS and Surrounding Counties

At reputed company, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality 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, affordable, and reputed company. Ready to reputed company a difference? Join us to start Caring. Connecting. Growing... together. The Senior Clinical Quality RN will focus on tasks that occur in accordance with State, CMS or other requirements as applicable. This position will also be responsible for direction and guidance on provider-focused, clinical quality improvement and management programs. This role assists contracted providers with analyzing member care, trending quality compliance at the provider level, and developing action plans and programs to support provider practices in reputed company quality improvement using approved clinical practice guidelines, HEDIS, CMS, NCQA and other tools. Position reports to the Quality Leadership of the Health Plan. This is a home-based office position with field responsibilities up to 75% of the time. Travel to counties of Cherokee, Crawford, Bourbon, Linn, Miami, Johnson, Wyandotte, Douglas, Franklin, Anderson, Allen, Neosho, Labette, Montgomery, Wilson, Woodson, Coffey, Osage, Greenwood, Elk, and Chautauqua, KS based on business needs. If you are located reputed company Kansas City, KS or surrounding counties you will have the flexibility to telecommute* as you take on some tough challenges. Primary Responsibilities • Supports effective deployment of program at the practice level through strategic partnerships with participating practitioners and practice staff while assessing trends in quality measures and identifying opportunities for quality improvement • 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 liaison with key vendors supporting HEDIS / State Measures; consults with vendors to design and implement initiatives to innovate 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 focused on quality improvement, member health education and disparity programs as assigned • Coordinates and performs onsite clinical evaluations through medical record audits to determine appropriate coding and billing practices, compliance with quality metrics, compliance with service delivery and quality standards • Investigates gaps in clinical documentation where system variation has impact on reputed company calculation, provides feedback to appropriate team members where issues are verified, and monitors resolution to conclusion • Works with providers on standards of care, and advises providers on established clinical practice guidelines, and appropriate documentation and billing consistent with state specific measures and technical specifications What Are The Reasons To Consider Working For reputed company? Put It reputed company Together - Competitive reputed company Pay, a Full And Comprehensive Benefit Program, Performance Rewards, And a Management Team Who Demonstrates Their Commitment To Your Success. Some Of Our Offerings Include • Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays • Medical Plan options along with participation in a Health Spending Account or a Health Saving account • Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage • 401(k) Savings Plan, Employee Stock Purchase Plan • Education Reimbursement • Employee Discounts • Employee Assistance Program • Employee Referral Bonus Program • Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.) • More information can be downloaded at: http://uhg.hr/uhgbenefits You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications • reputed company unrestricted RN licensure in state of Kansas • 2+ years clinical experience as an RN • 2+ years of experience with quality improvement • Intermediate level of proficiency in MS Office including Word, reputed company, Outlook • reputed company, non-restricted state of Kansas driver’s license and state-required insurance • Access to reliable transportation and the ability to travel up to 75% of the time to providers • Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI) • Live in a location that can receive a reputed company approved high-speed internet reputed company or reputed company an existing high-speed internet service Preferred Qualifications • BSN, Master's Degree (or higher) in Clinical Field • HEDIS; NCQA experience • Experience leading teams or individuals for reputed company quality outcomes • Health care and insurance industry experience, including regulatory and compliance • Background in Managed Care • reputed company Telecommuters will be required to adhere to reputed company’s Telecommuter Policy. 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 everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity 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 color, historically marginalized groups, and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes — an enterprise reputed company reflected in our mission. Diversity creates a healthier atmosphere: reputed company is an Equal Employment Opportunity / Affirmative Action employer, and reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national reputed company, protected veteran status, disability status, sexual orientation, gender identity or expression, 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. #RPO #Red Apply Job!