RN - Quality and Provider Education Specialist

3 weeks ago


Grand Rapids, Michigan, United States OpTech Full time

Job Title: RN - Quality and Provider Education Specialist


OpTech is a woman-owned company that values your ideas, encourages your growth, and always has your back. When you work at OpTech, not only do you get health and dental benefits on the first day of employment, but you also have training opportunities, flexible/remote work options, growth opportunities, 401K and competitive pay.


Responsibilities:


  • Provide comprehensive research and responses for identified problems and complex inquiries related to the provider community
  • Conduct in-state provider educational sessions in person on relevant topics such as new business tools, billing/coding, HEDIS, medical record reviews, etc.
  • Perform clinical reviews with knowledge of clinical documentation, body systems, anatomy and physiology
  • Scan records as required
  • Develop and maintain an effective, professional working relationship with providers and their staff
  • Support providers in closing treatment opportunities (HEDIS/Star measures)
  • Assist leaders in monitoring issues, projects, timelines, and plans related to various corporate initiatives impacting providers
  • Research, analyze, identify, and evaluate data to assess existing trends and issues
  • Recommend, communicate, and implement solutions to identified problems and root cause of issues
  • Represent and participate in group discussions
  • Assist other departments / consultants when visiting providers to discuss a variety of HEDIS/Star related topics
  • Generate summary of activity monthly and as requested


Qualifications:


  • Current unrestricted state of Michigan registered nurse license required
  • Knowledge of quality improvement / process improvement / clinical guidelines
  • Experience with MS Office skills. Excel and SharePoint are a plus


OpTech is an equal opportunity employer and is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, status as a parent, disability, age, veteran status, or other characteristics as defined by federal, state or local laws.



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