HS Quality Clinical Coordinator Specialist - RN/LCSW
Location: Birmingham Alabama
Description: Cigna is presently looking of HS Quality Clinical Coordinator Specialist - RN/LCSW right now, this career will be placed in Alabama. Further informations about this career opportunity please give attention to these descriptions. Job Description
Responsible for conducting the functions of Quality Management in a timely, efficient manner and ensuring achieve! ment of QM objectives. Specific responsibilities include, but are not limited to: creating and maintaining quality management files; reviewing all potential QM cases; performing special studies or audits; conducting office site visits and medical records reviews, supporting preparations for regulatory audits. Leads clinical quality improvement through focused activities on the HEDIS process and other clinical studies. Evaluate the need for clinical intervention and, as appropriate, assess, analyze, plan, implement and evaluate intervention options to assure success. Identify actions required to improve performance and work with regional and national teams to improve results. Define and document policies, procedures and processes. Current LVN/LPN/RN with B.S. degree or equivalent work experience. Three to five years of quality review and improvement experience preferred. Experience with NCQA standards, quality management preferred. Strong project management, research and ana! lytical skills..
RESPONSIBILITIES:
Assist ! with project management activities, which may include HEDIS, CAHPS, and HOS. May perform medical record reviews to assess physician compliance with documentation standards. Assist in the facilitation of and preparation for the results of findings and / or quality committee meetings. Maintain tracking logs. May conduct training on managed care principles, scope of projects, automated systems, department policies and procedures, and work processes. May maintain records of findings, make recommendations, report findings, and create corrective action plans. May oversee Inter-rater Reliability Review related to specific projects. May assist in the preparation of QIA required documentation, and participate in design and preparation of all compliance related documentation. Support the identification and implementation of market wide quality improvement initiatives including the analysis of data, defined interventions, monitoring intervention roll out, and re-measurement of key met! rics. May actively participate in committee meetings. .
Requirements
QUALIFICATIONS:
Minimum: Registered Nurse (RN) license or Licensed Clinical Social Worker (LCSW) in applicable state. At least three years of managed care clinical experience. Prior quality experience. Knowledge of regulatory audits and regulations.
Preferred: Manage care experience, ideally with Medicare or Medicaid HMO. ICD-9 or previous coding experience for Health Services. Regulatory compliance experience. HEDIS and NCQA survey experience for Health Services. Knowledge of Microsoft Office products. .
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If you were eligible to this career, please email us your resume, with salary requirements and a resume to Cigna.
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This career starts available on: Sat, 23 Mar 2013 00:22:37 GMT
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