o Recommend workflow efficiencies to providers and their staff to improve HEDIS scores and desired patient outcomes.
o Train provider offices on specific provider incentive programs, secures participation, tracks progress, and makes recommendations for success.
o Identify member service gaps and review reports with providers and their staff.
o Works with providers to actively close identified service and care gaps.
o Actively partner with corporate CDT and Health Care Network teams.
o Monitors and validates member attribution lists and provider directory information in alignment with contract requirements.
o Assists with medical record review, supplemental data submission, abstraction, overreading as necessary to meet Health Plan goals.
o Additional quality management and improvement tasks as identified.
Requirements
Qualifications:
· Experience working with providers and provider office staff
· Clinical background as LPN, RN or LCSW or other applicable license or certification as determined by the Company is preferred
· Effective verbal and written communication skills
· Excellent interpersonal skills
· Ability to juggle multiple priorities simultaneously
· Innovative critical thinker
· Ability to work independently and productively in a remote environment
· Excellent project management and organizational skills
· Knowledge of and experience working in EMR systems
All Supplier staff must be proficient with computer skills, including but not limited to: MS Outlook, MS Teams, MS Excel, MS Word, web-based applications, SharePoint, searching and saving files, and navigating between multiple programs simultaneously.
About the Company
RepuCare, a certified Woman-Owned Business Enterprise (WBE), is a leader in delivering innovative workforce solutions across the healthcare industry. We are proud to partner with a large, nationally recognized managed care organization to recruit a dedicated Quality Consultant (HEDIS Specialist) to join their dynamic team.
