Registered Nurse RN Quality Practice Advisor
Company: Maxim Government Services
Posted on: May 25, 2019
Other opening in Raleigh, North Carolina. This and other rn jobs
brought to you by NursingJobCafe.com Maxim Healthcare Services
currently has an opening for a Field Care Manager RN to work for a
health care company in Raleigh, NC. ***This is a Direct Placement
position*** so you will be hired directly by the client
- A Fortune 200 Company
- Voted World's Most Admired Company
- Focuses exclusively on government-sponsored healthcare
- Full benefits available including 401k with company match and
- Paid time off starting with 18 days. Job summary: Establishes
and fosters a healthy working relationship between large physician
practices, IPAs and WellCare. Educates providers and supports
provider practice sites in regards to the National Committee for
Quality Assurance (NCQA) HEDIS measures. Provides education for
HEDIS measures, appropriate medical record documentation and
appropriate coding. Assists in resolving deficiencies impacting
plan compliance to meet State and Federal standards for HEDIS. Acts
as a resource for the market on HEDIS measures, appropriate medical
record documentation and appropriate coding. Supports the
development and implementation of quality improvement interventions
and audits in relation to plan providers. Key Duties and
- Advises and educates large Provider practices and IPAs in
appropriate HEDIS measures, medical record documentation guidelines
and HEDIS ICD-9/10 CPT coding in accordance with NCQA
- Collects, summarizes and trends provider performance data to
identify and strategize opportunities for provider
- Collaborates with Provider Relations to improve provider
performance in areas of Quality, Risk Adjustment and Operations
(claims and encounters).
- Delivers provider specific metrics and coach providers on gap
- Identifies specific practice needs where WellCare can provide
- Develops, enhances and maintains provider clinical relationship
across product lines.
- Defines gaps in WellCare's service relationship with providers
and facilitate resolution.
- Leads and/or supports collaborative business partnerships,
elicit client understanding and insight to advise and make
- Partners with physicians/physician staff to find ways to
explore new ways to encourage member clinical participation in
wellness and education.
- Provides resources and educational opportunities to provider
- Captures concerns and issues in action plans as agreed upon by
- Documents action plans and details of visits and outcomes and
reports critical incidents and information regarding quality of
- Communicates with external data sources as needed to gather
data necessary to measure identified outcomes.
- Provides communication such as newsletter articles, member
education, outreach interventions and provider education.
- Supports quality improvement HEDIS and program studies as
needed, requesting records from providers, maintaining databases,
and researching to identify members' provider encounter
- Ensures that documentation produced and/or processed complies
with state regulations and/or accrediting bodyrequirements.
- Ensures assigned contract/regulatory report content is accurate
and that submission adheres to deadline.
- Participates in and represents plan at community, health
department, collaborative and other organizational meetings
focusing on quality improvement, member education, and disparity
programs, as assigned.
- Ensures accuracy in medical records for data collection, data
entry and reporting. Enters documentation of findings in identified
- Performs other duties as assigned.Requirements:
- Bachelor's Degree in Healthcare, public health, nursing,
psychology, health administration, social work or related field
- 3+ years directly related HEDIS record collection with
analytical review/evaluation and or Quality Improvement OR
- A Master's Degree in Healthcare, public heath, nursing,
psychology, health administration, social work or related
- 1+ year of managed care experience For immediate consideration,
please forward an updated copy of your resume to Leonard Badham @
You can reach me direct at (office) or (mobile).
Keywords: Maxim Government Services, Cary , Registered Nurse RN Quality Practice Advisor, Healthcare , Raleigh, North Carolina
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