DescriptionThe Quality Improvement Nurse develops and grows positive, long-term relationships with physicians, providers and healthcare systems in order to support and improve financial and quality performance within the contracted working relationship with the health plan. The Provider Engagement Professional 1 work assignments are often straightforward and of moderate complexity.
This role is primarily telephonic with 10-15% travel for in person meetings.
The hours are Mon-Fri 8am-5pm est.
The Quality Improvement Nurse represents the scope of health plan/provider relationship across such areas as financial performance, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance, operational improvements and other areas as they relate to provider performance, member experience, market growth, provider experience and operational excellence. Understands own work area professional concepts/standards, regulations, strategies and operating standards. Makes decisions regarding own work approach/priorities, and follows direction. Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation.
- Active RN or LPN license in VA
- 1-3 years of clinical experience with the senior population
Excellent computer skills, specifically Work, Excel and Outlook, and ability to easily navigate multiple applications
Ability to work independently under general instructions and with a team
Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); recommended speed is 10Mx1M
- Bachelor's Degree
- Managed care
- Experience identifying gaps in care and recommending process improvements
- Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality/bonus performance
- Comprehensive knowledge of Medicare policies, processes and procedures
As part of our hiring process for this opportunity, we will be using a technology called Montage Voice which allows us to quickly connect and gain valuable information from you about your relevant experience.
If you are selected for a phone screen you will receive an email inviting you to participate in a Montage Voice interview. During this call you will be asked a set of questions pertaining to this particular role and you will provide recorded responses. The entire process takes about 15-20 minutes and can be done at your convenience. Your responses will be reviewed and you will be informed if you were selected for an in person or video interview, depending on your location.
Scheduled Weekly Hours40