RN Senior Clinical Quality Consultant Compact Lics CST
About the positionResponsibilities• Strictly adheres to department's metrics and established advanced protocols and to handle incoming contacts including, but not limited to, prescription refill requests, lab results, x-ray results, medical inquiries, patient education and referral requests• Primarily to make outbound calls but occasionally help manage the inbound call queue from patients, patient representatives, providers and other medical staff, while strictly adhering to established protocols and scripting• Review patient chart (in EMR) to ensure core measures are being addressed and met per protocol and takes appropriate action when they are not, i.e., schedule services• Complete patient assessments for Transition of Care Medication Reconciliation Post Discharge, Care for Older Adults Pain and Function Assessments• Educate patients on health conditions and necessity of route screening but assisting with appointment scheduling (A1c, Breast Cancer Screening, Colorectal Cancer Screening, Diabetic Eye Exam, etc.)• Communicate with providers and offices to obtain needed evidence of completed lab work, screenings and care provided• Review available medical records for core measures to submit for closure of HEDIS/STARS measures• Assist patients with identification of and connectivity to community and program resources to assist with non-medical needs, (Pharmacy assistance programs, meals on wheels, LIS)• Document thoroughly all calls and actions taken within core systemsRequirements• Active, unrestricted Registered Nurse license• Have Compact License and willing to support CST• 4+ years of RN experience, including experience in a managed care setting• 2+ years of experience in HEDIS/Star programs, preferably in a clinical quality consultant role• 2+ years of call center experience• 2+ years of experience with data analysis and/or quality chart reviews.Must be able to review paper and electronic medical records and charts• Proven solid knowledge of the Medicare HEDIS/Stars measures• Experienced using bolthires office applications, including databases, word-processing, outlook, and excel spreadsheets. Must be proficient in Excel• Demonstrated ability to interact with medical staff, peers, and internal company staff at all levels• Demonstrated ability to manage multiple complex, concurrent projects• Proven excellent written and verbal communication and relationship building skills• Demonstrated solid problem-solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action• Proven excellent customer service skills and communication skillsNice-to-haves• Undergraduate degree or post graduate degree• Billing and CPT coding experience• Clinical data abstraction experience• Proven adaptable to change• Proven good business acumen, especially as it relates to MedicareBenefits• Comprehensive benefits package• Incentive and recognition programs• Equity stock purchase• 401k contribution Apply tot his job