RN Quality and Provider Education

Grand Rapids, MI - USA

Monthly Salary: Not Disclosed

Posted on: 3 hours ago

Vacancies: 1 Vacancy

Job Summary

Overview:

TekWissen is a global workforce management provider headquartered in Ann Arbor Michigan that offers strategic talent solutions to our clients world-wide. Our client is a health insurance company. It offers different types of health care coverage plans that include individual and family dental and vision plans for employers etc.

Title: RN - Quality and Provider Education

Work Location: Grand Rapids MI 49503

Duration: 12 Months

Job Type: Temporary Assignment

Work Type: Hybrid/Remote

Dept: Quality and Provider Ed

Engagement Description:

Preferably knowledgeable of NCQA HEDIS measures medical record review.
This work will involve participating in provider visits to develop partnerships provide training education and review of medical records as well as other requests that support a variety of corporate initiatives.
This would also require traveling to member homes to complete bone mineral density (BMD) screenings.
The candidate must be licensed as a Registered Nurse in the state of Michigan and have a dependable vehicle.
In-state travel requirements vary throughout the year and could be up to five days a week at times.
Mileage Reimbursement: Total miles - normal commuter miles reimbursement

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned:

Provide comprehensive research and responses for identified problems and complex inquiries related to the provider community
Conduct activities as assigned such as in-home Bone Mineral Density (BMD) testing on members
Conduct in-state provider educational sessions in person and virtually on relevant topics such as new business tools billing/coding Health e-Blue (HeB) HEDIS medical record reviews etc.
Perform clinical reviews with knowledge of clinical documentation body systems anatomy and physiology preventative screening etc. Scan records as required.
Develop and maintain an effective professional working relationship with providers and their staff
Support providers in closing treatment opportunities (HEDIS/Star measures)
Assist leaders in monitoring issues projects timelines and plans related to various corporate initiatives impacting providers
Research analyze identify and evaluate data to assess existing trends and issues
Recommend communicate and implement solutions to identified problems and root cause of issues
Represent and participate in group discussions
Assist other departments / consultants when visiting providers to discuss a variety of HEDIS/Star related topics
Generate summary of activity monthly and as requested

QUALIFICATIONS:

To perform this job successfully an individual must be able to effectively execute each essential duty.
Contractors will be expected to attend annual training on HEDIS measures at the beginning of each year and must pass according to predetermined testing requirements.
The requirements listed below are representative of the knowledge skill and/or ability required throughout the year although others may be needed.

Top 3 Required Skills/Experience:

Current unrestricted state of Michigan registered nurse license required
Knowledge of quality improvement / process improvement / clinical guidelines
Experience with MS Office skills. Excel is a plus

Required Skills/Experience:

Valid MI driver s license; willing to drive to provider locations and travel throughout Michigan as needed (no exceptions)
Have a dependable vehicle every workday and be willing to travel up to five days a week (varies dependent on time of year however travel tends to average mostly 1-3 days per week)
Minimum three years of clinical experience

Preferred Skills/Experience:

Knowledgeable of NCQA HEDIS medical record review
Bachelor s degree in nursing
Strong knowledge and experience in use of software (e.g. Excel Outlook PowerPoint Word etc.).
Effective communication skills written and verbal
Experience in provider consulting/relations
Strong analytical organizational planning and problem-solving skills
Ability to effectively interface with employees at all levels
Ability to understand and apply statistical inference including research principles
Demonstrated medical and clinical knowledge required to analyze related issues and apply principles to health care business environment.

Education/Certifications:

R.N. licensed in Michigan; BSN degree preferred.
Associate degree acceptable with professional experience.

TekWissen Group is an equal opportunity employer supporting workforce diversity.

Overview: TekWissen is a global workforce management provider headquartered in Ann Arbor Michigan that offers strategic talent solutions to our clients world-wide. Our client is a health insurance company. It offers different types of health care coverage plans that include individual and family ...