Register
Recruit Create CV
Unfortunately, this job posting is expired.
Don't worry, we can still help! Below, please find related information to help you with your job search.
Related keywords
Some similar recruitments
Virtual Navigator Jobs
Recruited by EdenHealth 8 months ago Address , Remote $49,600 - $62,000 a year
Auditor (Retail) Jobs
Recruited by Cotiviti 8 months ago Address , Remote From $19.20 an hour
Sr Auditor Jobs
Recruited by Entrust Datacard 8 months ago Address , Remote $95,000 - $145,000 a year
Data Entry Specialist Remote - Must Live Within Vicinity Of Madison, Wi Campus Location
Recruited by Wis Phys Svc Ins Corp 9 months ago Address , Madison, 53718 $16.40 an hour
Qa Engineer (Fully Remote In Select Locations)
Recruited by WebstaurantStore 9 months ago Address , Tampa, 33614, Fl
Heavy Highway Construction Positions In Stuart, Va
Recruited by Branch Civil 9 months ago Address , Stuart, 24171, Va
Nurse Patient Navigator Jobs
Recruited by St. Joseph's Health 9 months ago Address , Paterson, 07503, Nj
Medicaid Project Manager Jobs
Recruited by State of Iowa - Executive Branch 9 months ago Address Des Moines, IA, United States
Rehabilitation Associate – Juvenile Reentry Navigator
Recruited by State of Iowa - Executive Branch 9 months ago Address Des Moines, IA, United States
Regional Manager - Must Be Open To Relocation To Minnesota
Recruited by The Connor Group 10 months ago Address Iowa, United States
Dispatch Specialist - Remote In Az, Co, Id, Mn, Sd
Recruited by Lumen 11 months ago Address , Remote $12 - $21 an hour
Customer Service Representative - Remote (Must Live In Tampa Fl)
Recruited by OneTouch Direct 11 months ago Address , Tampa, 33634, Fl $12.50 - $13.75 an hour
Healthcare Auditor Jobs
Recruited by State of Iowa - Executive Branch 11 months ago Address Des Moines, IA, United States
Care Navigator Jobs
Recruited by Ascension 11 months ago Address , Remote From $15 an hour
Patient Navigator- Administrative Office
Recruited by Eastern Iowa Health Center 11 months ago Address Cedar Rapids, IA, United States
Medicaid Business Analyst Jobs
Recruited by Maximus 11 months ago Address , Remote Up to $80,000 a year
Health Navigator Jobs
Recruited by Hire Velocity 1 year ago Address Des Moines, IA, United States
Health Navigator Jobs
Recruited by Hire Velocity 1 year ago Address Lamoni, IA, United States
Health Navigator Jobs
Recruited by Hire Velocity 1 year ago Address Marshalltown, IA, United States
Medicaid Executive Officer 1-Medicaid Pharmacy Support
Recruited by State of Iowa - Executive Branch 1 year ago Address Des Moines, IA, United States
Rn - Liaison Nurse - Case Manager Per Diem Remote - Must Live In Washington State
Recruited by Kaiser Permanente 1 year ago Address , Bremerton, Wa $43.85 - $61.90 an hour
Scholarprep Navigator I Jobs
Recruited by The Village Method 1 year ago Address , Remote $15 - $20 an hour
Adherence Navigator Supervisor Rn
Recruited by CareMetx LLC 1 year ago Address , Remote
Snf Medicaid Coordinator/ Business Office Manager
Recruited by Corridor 1 year ago Address , Remote $20 - $28 an hour
Remote Patient Monitoring_Evenings
Recruited by Sentara Healthcare 1 year ago Address , Williamsburg, 23188, Va
Remote Patient Monitoring Tech_Part Time_Evenings
Recruited by Sentara Healthcare 1 year ago Address , Williamsburg, 23188, Va
Medicaid Regional Administrator Jobs
Recruited by State of Louisiana 1 year ago Address , Thibodaux, La $5,098 - $10,038 a month
Customer Care Rep 1- Remote (Must Live In Central Time Only)
Recruited by Sally Beauty Holdings 1 year ago Address , Remote
Medicaid Program Specialist 1-2
Recruited by State of Louisiana 1 year ago Address , Monroe, La $2,883 - $5,675 a month
Account Manager In The It World Must Be In Us
Recruited by Gretrix LLC 1 year ago Address , Remote $12 an hour
Care Transition Navigator Jobs
Recruited by Washington Hospital 1 year ago Address , Fremont, 94538, Ca $154,981 - $209,206 a year

Quality Navigator - Healthy Blue Medicaid - Remote - Must Reside In Sc

Company

BlueCross BlueShield of South Carolina
Address , , Sc
Employment type FULL_TIME
Salary
Expires 2023-07-29
Posted at 11 months ago
Job Description
Summary
Abstracts and reviews medical records for HEDIS (Health Plan Employer Data Information Set) for both prospective and retrospective seasons to ensure that our Company complies with NCQA (National Committee for Quality Assurance) standards and achieves its CMS (Centers for Medicare & Medicaid Services) Star rating. Performs quality improvement activities to monitor/maintain quality of care and compliance with applicable standards/regulations. Educates network providers on HEDIS clinical measures and coding accuracy . Responsible for continuing education on HEDIS/NCQA measures. Performs/coordinates HEDIS data collection, and NCQA accreditation activities.

Description

Logistics
  • This position is full time (40 hours/week) Monday-Friday, 8:00 am – 4:30 or 8:30 am – 5:00 pm,
  • Position will be fully remote.
  • Candidate must reside in South Carolina.
  • Travel to provider offices to provide education and training will be required.
What You Will Do:
  • Perform quality improvement activities to monitor and maintain quality of care and compliance with applicable standards, and regulations.
  • Educate network providers on HEDIS clinical measures and coding accuracy.
  • Responsible for continuing education on HEDIS/NCQA measures.
  • Perform HEDIS data collection and NCQA accreditation activities
  • Participate in other assigned projects.
  • Performs/coordinates HEDIS data collection and NCQA accreditation activities.
To Qualify for This Position, You Will Need:
  • Strong understanding of managed care.
  • Proficient spelling, grammar, punctuation, and basic business math.
  • Previous HEDIS and or provider education experience.
  • Medical coding knowledge and or experience.
  • Active, unrestricted RN licensure from the United States and in the state of hire OR an active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC).
  • Ability to handle confidential or sensitive information with discretion.
  • Four years of clinical experience including two years of experience in a clinical area providing patient care.
  • Associate Degree - Nursing OR bachelor’s degree – Nursing.
  • Microsoft Office, various provider EMRs, and database software.
  • Demonstrate ability to identify the need for and implement corrective actions.
  • Excellent verbal and written communication.
  • Customer service, organizational, presentation, problem-solving, and analytical or critical thinking skills.
What We Prefer
  • Knowledge of the National Committee for Quality Assurance (NCQA).
  • Presentation skills.
  • Portability/Accountability Act (HIPAA) standards/regulations.
  • Excellent organizational and time management skills.
  • Knowledge of US DOL and Health Insurance
  • Two years of health insurance experience.
  • Knowledge of Utilization Review Accreditation Commission (URAC).
  • Previous HEDIS, provider education, and medical coding experience.
  • Knowledge of the South Carolina Department of Insurance (SCDOI).
  • Knowledge of claims systems.
  • Provider education and training experience strongly preferred.
  • Two years of utilization medical review, quality assurance,
What We Can Do for You
  • On-site cafeterias and fitness centers in major locations
  • Incentive Plan
  • Tuition assistance
  • Continuing education funds for additional certifications and certification renewal
  • Service recognition
  • Wellness programs and healthy lifestyle premium discount
  • Nine paid holidays
  • 401(k) retirement savings plan with company match
  • Paid annual leave – the longer you work here, the more you earn
  • Subsidized health plans and free vision coverage
  • Life insurance
  • Merit Plan
What to Expect Next
After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and salary requirements.
Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.
Equal Employment Opportunity Statement
BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.
We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.
If you need special assistance or an accommodation while seeking employment, please e-mail [email protected] or call 1-800-288-2227, ext. 43172 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.