Stars Improvement Clinical Professional 2 - Conviva Care Solutions - San Antonio TX

Profile

Description

The Stars Improvement, Clinical Professional 2 responsible for the development, implementation and management oversight of the company's Medicare/Medicaid Stars Program. The Stars Improvement, Clinical Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

The Stars Improvement, Clinical Professional 2 This work focuses on areas of clinical emphasis. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Required Qualifications


Previous experience in a clinical setting or health plan operations environment.
Experienced clinical background as RN, LPN or LVN.
Previous experience providing training and educating teams.
Previous experience working with NCQA's Medicare quality measures (HEDIS/Patient Safety/CAHPS_HOS); CMS quality measures. Minimum two - five years.
Previous experience providing training individually or in a group setting to clinical and operations teams focused on STAR/HEDIS measures specifications.
Experience retrieving supplemental data from patient's charts (HEDIS retrieval).
Quality or process improvement experience in an ambulatory setting. Strong analytic skills and ability to use data to drive improvement activities. Strong prioritization skills with ability to collaborate with multiple departments.
Must be able to work within a team but be able to make decisions and function independently and be self-directed and motivated.
Detail orientated and comfortable working with tight deadlines in a fast-paced environment
Excellent PC skills (including MS Word, Excel, and PowerPoint). Ability to navigate multiple EMRs to conduct chart review. Quick learner.
Willingness and ability to travel locally, to provider offices for the purpose of training and or chart review. Possibility of limited out of state travel.


Preferred Qualifications


Proficient with chart review/data mining.
Experience with quality improvement efforts aimed at improvements in Stars performance.
Ability to navigate various EMRs.
Knowledge of MRA coding is desirable but coding certification is not required.
BSN or bachelor's degree in a related field.
Experience with CPTll coding a plus.


Additional Information

Interview Format:

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire Text to enhance our hiring and decision-making ability. Modern Hire Text allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first round interview, you will receive an email correspondence inviting you to participate in a Modern Hire text interview. In this interview, you will read a set of interview questions and you will provide text responses to each question. You should anticipate this interview to take about 15 minutes. Your text interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from **** with instructions to add the information into the application at Humana's secure website.

Conviva Care Solutions is more than an equal opportunity employer, Conviva's dedication to promoting diversity, multiculturalism, and inclusion is at the heart of what we do in all of our Conviva roles. Diversity is more than a commitment to us, it is the foundation of what we do. We are fully focused on diversity of race, gender, sexual orientation, religion, ethnicity, national origin and all of the other fascinating characteristics that make us each uniquely wonderful.

Scheduled Weekly Hours

40

Company info

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