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RN - Quality and Provider Education
3 months ago
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.
1) Provide comprehensive research and responses for identified problems and complex inquiries related to the provider community.
2) Conduct activities as assigned such as in-home Bone Mineral Density (BMD) testing on members.
3) Conduct in-state provider educational sessions in person on relevant topics such as new business tools, billing/coding, Health e-Blue (HeB), HEDIS, medical record reviews, etc.
4) Perform clinical reviews with knowledge of clinical documentation, body systems, anatomy and physiology. Scan records as required.
5) Develop and maintain an effective, professional working relationship with providers and their staff.
6) Support providers in closing treatment opportunities (HEDIS/Star measures)
7) Assist leaders in monitoring issues, projects, timelines, and plans related to various corporate initiatives impacting providers.
8) Research, analyze, identify, and evaluate data to assess existing trends and issues.
9) Recommend, communicate, and implement solutions to identified problems and root cause of issues.
10) Represent and participate in group discussions.
11) Assist other departments / consultants when visiting providers to discuss a variety of HEDIS/Star related topics
12) Generate summary of activity monthly and as requested
To perform this job successfully, an individual must be able to effectively execute each essential duty. Contractors will be expected to attend annual training on HEDIS measures at the beginning of each year, and must pass according to predetermined testing requirements. The requirements listed below are representative of the knowledge, skill, and/or ability required throughout the year, although others may be needed.
Top 3 Required Skills/Experience -
• Current unrestricted state of Michigan registered nurse license required
• Knowledge of quality improvement / process improvement / clinical guidelines
• Experience with MS Office skills. Excel is a plus.
Required Skills/Experience - The rest of the required skills/experience. Include:
• Valid MI driver's license; willing to drive to provider locations and travel throughout Michigan as needed (no exceptions)
• RN with HEDIS experience but will interview qualified RNs. RNs with professional coding experience is a plus.
• Have a dependable vehicle every workday and be willing to travel up to five days a week and stay overnight when appropriate
• Minimum three years of clinical experience
Preferred Skills/Experience - Optional but preferred skills/experience. Include:
• Bachelor's degree in nursing
• Strong knowledge and experience in use of software (e.g., Excel, Outlook, PowerPoint, Word, etc.).
• Knowledge of NCQA HEDIS measures
• Medical chart review experience
• Effective communication skills, written and verbal
• Five years of experience in provider consulting/relations
• Strong analytical, organizational, planning, and problem-solving skills
• Ability to effectively interface with employees at all levels
• Ability to understand and apply statistical inference including research principles
• Demonstrated medical and clinical knowledge required to analyze related issues and apply principles to health care business environment.
Education/Certifications - Include:
• R.N. licensed in Michigan; BSN degree preferred. Associate degree acceptable with professional experience.
