RN Quality Care Coordinator - Quality emphasis
Network Health's success is rooted in its mission to create healthy and strong Wisconsin communities.
It drives the decisions we make, including the people we choose to join our growing team.
Network Health is seeking a Quality Care Coordinator.
This individual will be s subject matter expert supporting the quality efforts within Network Health.
The Quality Care Coordinator develops, implements and provides on going monitoring of intervention plans and quality gap closure.
The overall goal of this role is to reduce medical costs and improve quality ratings.
The Quality Care coordinator achieves this goal through member and/or provider engagement, internal quality process improvement work, and coordination of overall clinical intervention strategies.
The Quality Care Coordinator conducts HEDIS and year-round medical record reviews and is responsible for ensuring that Network Health meets all OCI, CMS and NCQA quality requirements.
Job Responsibilities Provide direct outreach to members and/or providers in order to close quality gaps and maintain or exceed expected population health outcomes per HEDIS, Stars and NCQA.
Creates written materials for members, physicians, and other customers in formats such as newsletters, brochures, self-care materials, educational handouts, letters and telephone scripts.
Responsible for development and coordination of member centric programs in alignment with industry and regulatory standards.
Evaluates utilization patterns, medical records and other metrics to monitor quality and efficiency results.
Provides clinical support for the appeals and grievance department and quality of care complaint process, preparing cases for medical director review when needed.
Identifies opportunities for improvement and implements clinical interventions.
Prepare and/or deliver presentations for Quality Management committee, clinic or provider education, and system-wide committees as needed.
Coordinates, monitors and documents quality interventions and care management programs with goal of effectiveness that promotes value added care and service.
Collaborates closely with secondary providers (Breathe at Ease, Home Telemetry, Diabetes programs) to coordinate services for members.
Functions as a liaison when needed for family, member and provider to communicate any current of potential issues.
Prepares reports as necessary.
Develop review and revise department policies and procedures including preventive services requirements.
Provides recommendations for preventive services medicine and evidence based clinical guidelines, seek approval and monitor for updates or relevant changes as assigned.
Research, submit and evaluate quality improvement projects regulated by CMS as assigned.
Implements systems of care that facilitate close monitoring of members to promote early intervention.
Other duties as assigned.
Job Requirements Associate degree in nursing required.
BSN preferred.
4 years clinical RN experience Experience in basic data analysis, quality improvement, or HEDIS medical record review, preventive care, or health plan experience preferred WI Registered Nurse (RN) This position is eligible to work remotely in the state of Wisconsin, assuming that you meet the requirements for a home office set up.
This role may require you to travel to local provider offices or clinics within our service area at times.
Travel to the Menasha (corporate office) may be required at times.
WARNING:
Please beware of phishing scams that promote work-at-home opportunities and which may also pose as legitimate companies.
Please be advised that Network Health recruiter will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for a role with our company.
All of our positions require that you first complete an online application.
Recommended Skills Business Process Improvement Certified Nurse Practitioner Clinical Works Content Management Health Policies Medical Records Estimated Salary: $20 to $28 per hour based on qualifications.
It drives the decisions we make, including the people we choose to join our growing team.
Network Health is seeking a Quality Care Coordinator.
This individual will be s subject matter expert supporting the quality efforts within Network Health.
The Quality Care Coordinator develops, implements and provides on going monitoring of intervention plans and quality gap closure.
The overall goal of this role is to reduce medical costs and improve quality ratings.
The Quality Care coordinator achieves this goal through member and/or provider engagement, internal quality process improvement work, and coordination of overall clinical intervention strategies.
The Quality Care Coordinator conducts HEDIS and year-round medical record reviews and is responsible for ensuring that Network Health meets all OCI, CMS and NCQA quality requirements.
Job Responsibilities Provide direct outreach to members and/or providers in order to close quality gaps and maintain or exceed expected population health outcomes per HEDIS, Stars and NCQA.
Creates written materials for members, physicians, and other customers in formats such as newsletters, brochures, self-care materials, educational handouts, letters and telephone scripts.
Responsible for development and coordination of member centric programs in alignment with industry and regulatory standards.
Evaluates utilization patterns, medical records and other metrics to monitor quality and efficiency results.
Provides clinical support for the appeals and grievance department and quality of care complaint process, preparing cases for medical director review when needed.
Identifies opportunities for improvement and implements clinical interventions.
Prepare and/or deliver presentations for Quality Management committee, clinic or provider education, and system-wide committees as needed.
Coordinates, monitors and documents quality interventions and care management programs with goal of effectiveness that promotes value added care and service.
Collaborates closely with secondary providers (Breathe at Ease, Home Telemetry, Diabetes programs) to coordinate services for members.
Functions as a liaison when needed for family, member and provider to communicate any current of potential issues.
Prepares reports as necessary.
Develop review and revise department policies and procedures including preventive services requirements.
Provides recommendations for preventive services medicine and evidence based clinical guidelines, seek approval and monitor for updates or relevant changes as assigned.
Research, submit and evaluate quality improvement projects regulated by CMS as assigned.
Implements systems of care that facilitate close monitoring of members to promote early intervention.
Other duties as assigned.
Job Requirements Associate degree in nursing required.
BSN preferred.
4 years clinical RN experience Experience in basic data analysis, quality improvement, or HEDIS medical record review, preventive care, or health plan experience preferred WI Registered Nurse (RN) This position is eligible to work remotely in the state of Wisconsin, assuming that you meet the requirements for a home office set up.
This role may require you to travel to local provider offices or clinics within our service area at times.
Travel to the Menasha (corporate office) may be required at times.
WARNING:
Please beware of phishing scams that promote work-at-home opportunities and which may also pose as legitimate companies.
Please be advised that Network Health recruiter will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for a role with our company.
All of our positions require that you first complete an online application.
Recommended Skills Business Process Improvement Certified Nurse Practitioner Clinical Works Content Management Health Policies Medical Records Estimated Salary: $20 to $28 per hour based on qualifications.
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