Clinical Practice Performance Consultant - Kauai, HI
At reputed company, were 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. If you are located on or near Kauai or Hawaii Counties, you will have the flexibility to work remotely* as you take on some tough challenges. Please note that this is a work from home opportunity, but you still need to live in or near the posted area to travel up to 75% of the time covering Kauai, Maui and Hawaii Counties Primary Responsibilities: Educates providers and office staff on proper clinical documentation, state-mandated quality metrics specifications, provider profiling and pay for performance measurement, and medical record review criteria, to drive quality improvement 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 Designs practice level quality transformation through targeted clinical education and approved materials reputed company to HEDIS/State Specific quality measures for provider and staff education during field visits Materials additionally include information from local, state, and national departments of health on key health reputed company issues (understanding, exploring, educating, and facilitating on a local level) 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 Identifies population-based member barriers to care and works with the QMP team to identify local level strategies to overcome barriers and reputed company clinical gaps in care Reports provider issue trends of concerns to the Health Plan Quality Director and work with other departments to resolve as needed 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 Identifying members in need of health education and/or services (case management, etc.) and refers members to the appropriate internal departments per policy Documents and refers providers' non-clinical/service issues to the appropriate internal parties, to include Provider Relations and the Plan Chief Medical Officer by analyzing provider records and ensuring follow through 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 Preparing and presenting quality data and initiative at Quality Committee meetings Youll 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: 4 years of experience in managed care or equivalent healthcare experience, including regular interaction with providers regarding clinical quality improvement processes Experience in designing and implementing quality improvement initiatives Experience in data interpretation and using data to inform decision-making Proficiency using a PC in a Windows environment, including reputed company Word, reputed company, and PowerPoint Access to reliable transportation, and reputed company of automobile insurance Ability to Travel to physician offices locally up to 75% of the time, including off reputed company travel Preferred Qualifications: reputed company unrestricted RN or MSW licensure in the State of Hawaii Experience working in Medicaid and/or Medicare Experience in managed care Experience working with behavioral health patients, members, or providers Account Management experience Knowledge of one or more of: clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements Multilingual Proven presentation skills with experience and comfortability presenting to others reputed company employees working remotely will be required to adhere to reputed companys Telecommuter Policy The salary range for this role is $71,600 to $140,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. reputed company complies with reputed company minimum wage laws as applicable. In addition to your salary, reputed company offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with reputed company, youll find a far-reaching choice of benefits and incentives. 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 everyoneof every race, gender, sexuality, age, location and incomedeserves 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. Apply Job!