We're seeking a compassionate and driven individual to join our team in a vital role, supporting physicians and members to achieve exceptional quality outcomes. As a member of our team, you'll play a crucial role in enhancing member access to care/services and driving greater adherence to preventive, safety, and chronic care requirements.
Your Responsibilities Will IncludeFacilitating patient compliance with preventive, safety, and chronic care requirements.
Conducting outreach to patients to ensure they understand and adhere to their care needs.
Interacting consistently with providers and their staff to share, discuss, and monitor available health plan and physician practice data.
Providing subject matter expertise and tools to address and resolve issues, resulting in better outcomes for our Medicare population.
Impacting clinical outcomes through interventions designed to improve compliance with quality standards such as HEDIS, Patient Safety, CAHPS, and HOS.
Interventions Will InvolvePresenting and discussing quality scorecard reports with assigned physicians regularly.
Conducting ongoing medical record reviews to monitor compliance with quality measures.
Facilitating interventions to close gaps in care, including direct outreach to educate patients.
Collaborating with physicians and staff for process improvement activities related to quality.
Serving as a resource for correct and complete medical record documentation.
Educating providers and office staff regarding quality measure requirements.
Timely communication of any changes in standard requirements or health plan policies related to quality.
Additionally, you'll work closely with provider offices to update member demographic information and collect supplemental data not reported through claims data.
Schedule: Monday-Friday, 8:00 am - 5:00 pm EST. Minimal travel may be expected (up to 25%).
Required QualificationsActive and unrestricted RN licensure in state of residence.
5 years of clinical experience.
2 years of managed care experience.
Must reside in Eastern Standard Time zone.
Preferred Qualifications3 years of leadership experience.
Bachelor's degree.
Pay RangeThe typical pay range for this role is $54,300.00 - $139,200.00. The actual base salary offer will depend on factors such as experience, education, and geography.
BenefitsIn addition to competitive compensation, we offer a comprehensive benefits package, including:
Medical, dental, and vision benefits.
401(k) retirement savings plan.
Employee Stock Purchase Plan.
Fully-paid term life insurance plan.
Short-term and long-term disability benefits.
Well-being programs, education assistance, and free development courses.
CVS store discount and discount programs with participating partners.
Paid Time Off (PTO), vacation pay, and paid holidays.
We're dedicated to caring for our colleagues and communities, and we invite you to join us in making a difference.
Employment Type: Full-Time