Clinical HEDIS Practice Advisor

Cypress, California

Intro:

Are you an experienced RN, Pharmacist, MD, LVN, DO, LCSW, APRN, or ANP with HEDIS experience looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes” to any of these questions – this is the position for you!

Position Summary for RN, Pharmacist, MD, LVN, DO, LCSW, APRN, or ANP :

This is a permanent job opportunity for a Registered Nurse to be a HEDIS subject matter expert in consultation with provider practices. This job does require regional traveling in the field. 50% in office and 50% in the field.

Pay Range: $ based on experience and licensure

Hours for this Position for RN, Pharmacist, MD, LVN, DO, LCSW, APRN, or ANP :

Monday thru Friday 8-5pm

Advantages of this Opportunity:

• Competitive salary
• Fun and positive work environment

Required Skills

What We Look For in RN, Pharmacist, MD, LVN, DO, LCSW, APRN, or ANP :

• Clinical license as an RN, pharmacist, LCSW, MD, DO, LVN, APRN, ANP, CPHARM, etc. Required
• 2+ years of experience in directly related HEDIS medical record review and/or Quality Improvement with experience in clinical data/chart reviews and providing clinical consultation and education to providers and provider staff
• 1+ year of experience in Managed care health services environment Required

Responsibilities

More Insight of Daily Responsibilities for RN, Pharmacist, MD, LVN, DO, LCSW, APRN, or ANP : 

• Functions as HEDIS subject matter expert in consultation with provider practices.
• Advises and educates Provider practices in appropriate HEDIS measures, medical record documentation guidelines and
• HEDIS ICD-9 / CPT coding in accordance with NCQA requirements.
• Collects, summarizes and trends provider performance data to identify and strategize opportunities for provider improvement.
• Collaborates with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment, Operations (claims and encounters).
• Conducts internal auditing for provider compliance with regulatory and NCQA accreditation standards, and monitors and provides consultation to departments to correct deficiencies.
• Communicates with external data sources as needed to gather data necessary to measure identified outcomes.
• Provides communication such as newsletter articles, member education, outreach interventions and provider education.
• Ensures accuracy in medical records for data collection, data entry and reporting. Enters documentation of findings in identified databases.
• Conducts additional ad hoc QI audits through medical record review. Provides education for providers around individual state regulatory requirements, health laws, and reporting requirements.
• Supports quality improvement program studies and HEDIS as needed, requesting records from providers, maintaining databases, and researching to identify members’ provider encounter history.
• Maintains HIPAA standards and confidentiality of protected health information. Reports critical incidents and information regarding quality of care issues.
• Ensures that documentation produced and/or processed complies with state regulations and/or accrediting body requirements.
• Ensures assigned contract/regulatory report content is accurate and that submission adheres to deadline.
• Works independently, under the supervision of the Quality Management leader.
• Participates in or coordinates with other department projects as needed.
• Participates in and represents plan at community, health department, collaborative and other organizational meetings
• focusing on quality improvement, member

Want More Information about RN, Pharmacist, MD, LVN, DO, LCSW, APRN, or ANP ?

Interested in hearing more about this great opportunity? Reach out to Marjorie Mora, Recruiting Consultant at marjorie@healthcaresupport.com for immediate consideration.

Why You Should Work For Us:

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

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Salary

Based on Experience