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RN Manager Utilization Review (232492-005)

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Company: Concentra

Location: Fort Lauderdale, FL

Date Posted: June 10, 2014

Source: Concentra

Tracking Code
232492-005
Job Description

This position is under MetCare a Humana Company.

The Ideal Candidate:

• Must be proficient with HEDIS, CAHPS and Star Ratings •
Leads by influence with the ability to engage and motivate staff toward success
and achievement of common goals • Strong problem solving and decision making
skills • An individual who is passionate about playing a key role in changing
the current health care insurance landscape. • Is eager to embrace the
challenges and opportunities inherent in a start-up initiative. • Has the desire
and ability to balance a commitment to meeting social needs while achieving
financial sustainability of the organization. • An individual who believes that
“how” we do things is as important as “what” we do and is interested in rolling
up their sleeves, in working collaboratively and cross functionally. Job

Description: RN Quality Manager for HEDIS. The Manager is responsible for
coordinating all HEDIS related activities, objectives, and ...

Tracking Code
232492-005
Job Description

This position is under MetCare a Humana Company.

The Ideal Candidate:

• Must be proficient with HEDIS, CAHPS and Star Ratings •
Leads by influence with the ability to engage and motivate staff toward success
and achievement of common goals • Strong problem solving and decision making
skills • An individual who is passionate about playing a key role in changing
the current health care insurance landscape. • Is eager to embrace the
challenges and opportunities inherent in a start-up initiative. • Has the desire
and ability to balance a commitment to meeting social needs while achieving
financial sustainability of the organization. • An individual who believes that
“how” we do things is as important as “what” we do and is interested in rolling
up their sleeves, in working collaboratively and cross functionally. Job

Description: RN Quality Manager for HEDIS. The Manager is responsible for
coordinating all HEDIS related activities, objectives, and analysis including
conducting performance improvement studies. The Manager provides ongoing
development, maintenance and evaluation of quality systems and strategies
focused on HEDIS and CAHPS for all products and services. This position has
oversight responsibilities for the quality of provided service delivery and
overall performance reviews. Position Responsibilities: • Responsible for the
management and direction of the HEDIS, CAHPS and STARS initiatives • Establishes
quality improvement objectives to meet the demographic and epidemiological needs
of the population served and provide high quality and culturally appropriate
care. • Ensures compliance with federal, state, and accreditation standards by
developing, implementing and maintaining compliance processes within the
department. • Ensures necessary steps are taken to achieve a successful year
over year improvement of HEDIS measures. • Works collaboratively with key health
care professionals toward identification of opportunities for improvement, trend
analysis, education that result in the development of appropriate action plans
for problem resolution. • Serve as a resource working with research staff in
study design, data collection, analysis, and reporting activities that support
quality improvement interventions, transparency, compliance regulatory
standards, and provider performance monitoring. • Represents HEDIS department by
participating in assigned committees and interdisciplinary workgroups.

Concentra's Data Protection Commitment
* Concentra is committed to protect patient data and to ensure privacy of personal and medical information.
* Every Concentra colleague has the responsibility to adhere to data protection principles.
* If a colleague's role includes handling or processing sensitive data, role-specific policies and requirements apply to ensure the protection of patient information.

Required Skills

Desired Skills & Experience:

• Registered Nurse • 3+ years’ experience in
Utilization and Quality Improvement • HEDIS experience • Strong critical
thinking skills, communication skills, and documentation skills • Statistical
ability to analyze data • Strong computer skills and experience with Microsoft
Office Suites including the development of spreadsheets • Compensation: A market
competitive base salary with a full employee medical, dental, vision, &
401(k) benefits package In addition to knowledge in HEDIS and CAHPS, a health
plan quality manager should also have some insight on HOS (Health Outcome
Surveys); the survey contains questions from CMS regarding physical and mental
health, chronic medical conditions, functional status, clinical measures and
other health indicators. -bilingual Spanish strongly preferred. Microsoft Suite
experience with a focus on spreadsheets; pivot tables Bachelor’s Degree in
Nursing -background in annual and on-going MRR (Medical Record Reviews)

Required Experience

EDUCATION/CREDENTIALS:
Graduate of an approved Registered nursing program.
Current registration/license in the state where employed.
Successful completion of UDS, BAT, PFT, FIT, certification.

JOB-RELATED EXPERIENCE:
Minimum one year experience in occupational health nursing or related field.

JOB-RELATED SKILLS/COMPETENCIES:
Demonstrated knowledge of occupational medicine requirements (state specific).
Demonstrated working knowledge of clinical operations.
Demonstrated ability to train medical assistants under the direction of the Center Medical Director.
Demonstrated excellent customer service and communication skills.
Demonstrated willingness to participate in Continuing Medical Education.

WORKING CONDITIONS/PHYSICAL DEMANDS:
Fast paced environment
Clinic Environment

This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management.

Concentra is an Equal Opportunity Employer M/F/Disability/Veteran

Job Location
Ft. Lauderdale, Florida, United States
Position Type
Full-Time/Regular

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