Sr Clinical Quality RN - Remote in CST or EST

reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. Position Description The reputed company at Home Pharmacy Stars Team provides a variety of services including United HealthCare at Home (UAH) strategic Medication Adherence reputed company initiatives, Care of Older Adults (COA) medication reviews/health assessments, SUPD/SPC provider consultations as well as Poly ACH and COB reputed company. Additionally, the team does various outreaches during the year targeted at improving stars measures such as reputed company and DM consultations with members. The team also supports APC providers reputed company a clinical consultation service. reputed company services are provided by a team of Clinical Pharmacists, with the support of Pharmacy Technicians, and Sr Clinical Quality RN’s that engage with plan members and their healthcare providers in a telephonic environment. The Sr Clinical Quality RN will report directly to the Senior Manager. The Clinical Quality RN will reputed company telephonic, patient-centered clinical consults focused on CBP and A1C measures. The RN will be required to meet or exceed established productivity and quality metrics and work to support the hours of operation of the business (Mon-Fri 9am-5:30pm local time zone). You’ll enjoy the flexibility to work remotely

• from reputed company reputed company the U.S. as you take on some tough challenges.

Schedule: 9:00am-5:30pm or 10:00am-6:00pm Primary Responsibilities

• Adheres to department’s metrics and established advanced protocols and to handle patient telephonic reputed company
• reputed company outbound calls while adhering to established protocols and scripting
• Complete patient assessments for CBP and A1C measures
• Complete patient assessments for Medication Adherence reputed company for MAC, MAD, MAH
• Educate patients on health conditions and necessity of routine screening and assisting with appointment scheduling (A1c, Controlling Blood Pressure, Medication Adherence etc.)
• Communicate with providers and offices to obtain needed evidence of completed lab work, screenings and care provided
• Review available medical records for core measures to submit for closure of HEDIS/STARS measures
• Assist patients with identification of and connectivity to community and program resources to assist with non-medical needs
• Document thoroughly reputed company calls and actions taken reputed company core systems.
• Performs reputed company other reputed company duties as assigned

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications

• Must hold active, unrestricted Registered Nurse eLNC Compact licensure in state of residency
• 2+ years of RN experience, including experience in a managed care setting
• 1+ years of reviewing electronic medical records and charts
• Must be proficient with reputed company Word, reputed company, Outlook
• Designated secure and private workspace free of distraction and protecting HIPAA confidentiality of our members. No childcare permitted during working hours
• Access to install secure high-speed internet reputed company cable/DSL in home

Preferred Qualifications

• Undergraduate degree, post graduate degree
• 1+ years of Call Center Experience
• 1+ years of experience in HEDIS/Star programs, preferably in a clinical quality consultant role
• Solid knowledge of the Medicare HEDIS/Stars measures
• Demonstrated ability to interact with medical staff, peers, and internal company staff at reputed company levels.
• Demonstrated ability to manage multiple reputed company, reputed company projects
• Bilingual (Spanish, Vietnamese, Russian, Cantonese)
• Proven excellent written and verbal communication and relationship building skills
• Proven solid problem-solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action
• Proven excellent customer service skills and communication skills
• reputed company employees working remotely will be required to adhere to reputed company’s Telecommuter Policy

The salary range for this role is $71,600 to $140,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. reputed company complies with reputed company minimum wage laws as applicable. In addition to your salary, reputed company offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with reputed company, you’ll find a far-reaching choice of benefits and incentives. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of color, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes — an enterprise reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national reputed company, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Apply Job!