Clinical Nurse Liaison Apply
You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Our client is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose: Seeking an RN, LPN or LVN in Northern Louisiana for this Remote/Field based position with 2+ years experience in Quality Measures or HEDIS. Will serve as a Clinical Nurse Liaison for external groups and providers regarding clinical information from the Operations and Medical Management teams
Implement and manage procedures for tracking, identifying and problem-solving operational issues
Interpret and present program results and develop data-driven analysis and metrics used to measure effectiveness and ROI of all current and new products
Act as the clinical representative in various meetings
Collaborate with staff to identify internal and external opportunities and initiate process changes to increase quality and improve staff, provider and member satisfaction
Serve as a resource and liaison on utilization, quality improvement, and case management activities
Partner with various staff, along with internal and external departments on provider education and outreach
Partner with regional leadership for providers requiring a clinical interpretation of results related to health plan reporting, data, and quality incentive payments
Support community and member initiatives with a focus on at risk targets
50% travel required (3 days per week)
Education/Experience: LPN or LVN license. RN license preferred. 4+ years of clinical nursing experience, preferably in a large primary care office or clinic setting working with Medicaid or the uninsured. Experience in conflict management or data reporting and evaluation. Experience working in managed care, utilization management, case management, or quality improvement preferred.
Additional Responsibilities Include: Collects, summarizes, and delivers provider quality performance data to strategize/coach on opportunities for provider improvement and gap closure. Educates provider practices on appropriate HEDIS measures, medical record documentation guidelines, and HEDIS ICD-10 CPT coding in accordance with State, Federal, and NCQA requirements. Educates, supports, and resolves provider practice sites' issues around HEDIS, Pharmacy, Member Experience, and Administrative measures.
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
Our client is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
