Clinical Practice Consultant RN - Syracuse, NY

There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isn't for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Start doing your life's best work.(sm)

RN needed for Clinical Practice Consultant in Syracuse, NY. 

This position is responsible for ongoing HEDIS collection and improvement activities at the health plan and reports to the Quality Management Leader.

Primary Responsibilities:

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  Coordinates and performs onsite medical record reviews at provider offices to determine appropriate coding and billing practices, compliance with quality metrics, compliance with service delivery and quality standards, and where assigned investigation of quality of care and member complaints relative to quality of care and service. Support continuum of member care by identifying members in need of health education, case management, etc.



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  Educates providers and office staff on proper coding and billing practices, HEDIS and state-mandated quality metrics specifications, provider profiling and pay for performance measurement, and medical record review criteria. Solicit identification of barriers the office faces in providing care to members



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  Supports the HEDIS medical record chase to support optimum HEDIS and quality metric reporting



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  Supports quality improvement program studies requesting records from providers, maintaining databases, and researching to identify members' provider encounter history



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  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



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  Performs annual medical record evaluation, follow-up education, practitioner intervention



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  Enter documentation of findings in identified database



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  Generally works independently, under the supervision of the Quality Management leader



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  Participates in or coordinates with other department projects as needed

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  RN with current licensure in NY



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  5+ years clinical experience



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  3+ years of HEDIS experience



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  2+ years of quality improvement experience



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  Ability to travel to physician offices; valid state-specific driver's license and reliable vehicle



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  Proficiency in software applications that include, but are not limited to, Microsoft Word, Microsoft Excel

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  Bachelors degree in Science preferred



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  Microsoft PowerPoint



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  Knowledge base of clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements, and the managed care industry



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  Strong organizational skills and ability to work both independently and with teams



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  Ability to evaluate medical records with attention to detail



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  Ability to interact with medical staff, peers, and internal company staff at all levels



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  Ability to make formal presentations in front of committee and work group environments



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  Ability to use databases and prepare reports as needed



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  Demonstrated ability to assist with focusing activities toward a strategic direction as well as develop tactical plans, drive performance and achieve targets



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  Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action



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  Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others