Quality Management Nurse Associate 2 in Atlanta, GA at Integrated Resources, Inc

Date Posted: 12/27/2019

Job Snapshot

Job Description

Duration:0-4 month(s)

Description/Comment:The Medicare RN consultant impacts the clinical outcomes of Medicare members though interventions designed to improve compliance with HEDIS, CAHPS, and HOS standards. Interventions include:
Present and discuss the quality scorecard report with assigned physicians on a monthly basis or as data becomes available
Educate providers and office staff regarding HEDIS, CAHPS, and HOS measure requirements
Collaborate with physician practices regarding verbal and written member outreach to close gaps in care
Conduct ongoing medical record reviews to monitor/track compliance with all quality measures and share findings with providers
Facilitate identification and implementation of interventions to close gaps in care
Collaborate with physician and staff for process improvement activities related to quality
Serve as a resource for correct and complete medical record documentation to meet standard requirements
Obtain results and reports from vendors and specialists as needed
Distribute educational material to the provider practice
Timely communicate any changes in standard requirements or health plan policies related to quality
Work with the provider office to correct/update member demographic information to support successful health plan member outreach, including completion of HRA and care plans on Special Needs Population members
Collect and enter supplemental data not reported through claims data

Additional Job Details:Background/Experience Desired: BSN or RN with current unrestricted state licensure, required. Member Assessments/Care Coordination. Experience with accessing EMR records for retrieving clinical information or abstracting records for quality capture. Comfortable with telephonic outreach clear, calm voice inflections. Computer proficiency with multi-tasking must be able to sort, filter, maintain databases. Experience with Medicare Advantage patients preferred.