Description:
Responsible for creating a partnership relationship with providers and other initiatives and implementing the concept of a Medical Home for our members to achieve this fully integrated and accountable system of care. Primary duties may include, but are not limited to: Assesses current practice patterns, assets and challenges utilizing Medical Home Index, NCQA Standards, HEDIS audits, site reviews and medical records reviews. In partnership with the PCP, evaluates results of the initial assessment. Establishes a project plan with the practice that establishes goals and objectives for improvement. Provides ongoing practice support and sustains the partnership. Establishes regular meetings to track progress. Identifies and facilitates at least one practice in each MPC region to become SSB Physician Champions by obtaining NCQA certification as a Patient Centered Medical Home. Improves the understanding and sensitivity to the unique needs of this population and the care givers. Requires an AS/BS in nursing; 5 years of managed care experience; 2 years of clinical experience; 2 years of professional presentations to small and large audiences; or any combination of education and experience. Current, unrestricted clinical license appropriate to field of specialty (LVN/LPN, RN, NP, PA, LCSW, LSW, etc.) as required. BSN or MSN preferred.
Skills:
LPN, HEDIS, icd-10, microsoft excel, EMR, chart review, Managed care, HMO, MCO, Microsoft Office, Public speaking
Top Skills Details:
LPN,HEDIS,icd-10,microsoft excel,EMR,chart review
Additional Skills & Qualifications:
Requires an AS in nursing.
BSN or MSN preferred.
5 years of managed care experience
2 years of clinical experience
2 years of professional presentations to small and large audiences or any combination of education and experience.
Current, unrestricted clinical license appropriate to field of specialty (LVN/LPN, RN, NP, PA, LCSW, LSW, etc.) as required.
Flexible
Hard-working
-MUST have computer skills and analysis capabilities in order to navigate ICD10 DX based on HEDIS Technical Specification requirements.
-MUST have an understanding of codes for services based on diagnosis and procedure. -MUST be research and detail oriented with the tenacity to find claim specific data for a specific measure within a given period of time.
-Knowledge of Microsoft office is required. -Requires effective written, oral, and interpersonal communication skills.
-It is preferred that candidates have basic Excel skills
-Ability to type 30-40 WPM
-Adobe pro knowledge.
-Prior HEDIS experience a plus.
About Actalent:
Actalent connects passion with purpose. Our scalable talent solutions and services capabilities drive value and results and provide the expertise to help our customers achieve more. Every day, our experts around the globe are making an impact. We’re supporting critical initiatives in engineering and sciences that advance how companies serve the world. Actalent promotes consultant care and engagement through experiences that enable continuous development. Our people are the difference. Actalent is an operating company of Allegis Group, the global leader in talent solutions.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
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