Quality Specialist Ambulatory – Managed Care

Silver Cross Hospital•Cheyenne, WY

11d•$36 - $46•Remote

About The Position

Position will be responsible for creating, implementing, and maintaining a vision and plan for providing improved quality clinical outcomes to patients in the private practice setting, in collaboration with the Senior Leadership team. We will work with all practices of SCHC on closing care gaps, helpings practices, hospital, and ancillary sites in coordinating patients’ care plan, and work side by side with clinical leadership in creating Quality strategy moving forward.

Requirements

A minimum of an Associate’s degree in nursing and two (2) years of experience in clinical documentation improvement or inpatient coding
Excellent verbal, written, presentation, computer, and interpersonal communication skills.
Currently licensed as a Registered Nurse (RN)
3-5 years clinical practical experience
2-3 years CM, discharge planning and/or home health care coordination experience
Excellent analytical and problem-solving skills
Effective communications, organizational, and interpersonal skills
Ability to work independently (remote working).
Proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint, as well as some special proprietary applications.
Efficient and Effective computer skills including navigating multiple systems and keyboarding

Nice To Haves

ICD-10-CM/PCS Coding training and certification

Responsibilities

Subject matter expert regarding the HEDIS product line
Represent the Clinical Integration product for both client and internal business process meetings
Collaboration with all affiliate service lines to impact HEDIS and Star ratings and to provide seamless client service
The position works closely with the Chief Medical Officer to ensure effective clinical, quality, and medical management operational processes and policies that align with targeted quality outcomes and goals for enrollees
Promotes linkage between utilization management, care coordination and quality improvement activities with partnered MSO
Acts as a role model for clinical staff, promoting education, development and adoption of practice transformation with focus on clinical workflow, member satisfaction, improved RAF scoring
Promotes collaboration while working closely with Director Value Based Care and Innovista, in conjunction with maintaining appropriate communication with CMO and Senior Leadership
Development, and implementation of Policies and Procedures for Clinical Operations in the clinical office setting
Responsible for oversight of clinical training activities and outcomes.