Value Based Case Management Senior Analyst - RN - Philadelphia, PA

Health Care Service Corporation•Philadelphia, PA

2d•Hybrid

About The Position

At CareAllies, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Job Summary This position is responsible for coordinating and manage relationships with participating provider practices. Maintain detailed understanding of HEDIS / STAR performance measures. Develop and maintain a process to ensure all customers participating in provider practices meet all quality metrics. Responsible for coordinating the delivery of cost-effective, quality –based health care services for health plan customers by development and implementation of alternative treatment plans that address individual needs of the customer, their benefit plan, and community resources. Plans, implements, and evaluates appropriate health care services in conjunction with the physician treatment plan. Utilizes clinical skills to assess, plan, implement, implement, coordinates, monitor and evaluates options and services to facilitate appropriate healthcare outcomes for customers.

Requirements

Current Licensure as a registered nurse, in the state of residence in good standing.
Associates degree, diploma, or B.S. in Nursing
Three to Five (3-5) years recent experience in an acute-care environment, case-management, or utilization management position (experience can be a combination of LVN/RN licensure)
Previous HEDIS and/or CMS STARs experience a plus.

Nice To Haves

Bilingual (English/Spanish)
Previous HEDIS and/or CMS STARs experience
Strong proficiency level using Microsoft Excel

Responsibilities

Coordinating and manage relationships with participating provider practices.
Maintain detailed understanding of HEDIS / STAR performance measures.
Develop and maintain a process to ensure all customers participating in provider practices meet all quality metrics.
Responsible for coordinating the delivery of cost-effective, quality –based health care services for health plan customers by development and implementation of alternative treatment plans that address individual needs of the customer, their benefit plan, and community resources.
Plans, implements, and evaluates appropriate health care services in conjunction with the physician treatment plan.
Utilizes clinical skills to assess, plan, implement, implement, coordinates, monitor and evaluates options and services to facilitate appropriate healthcare outcomes for customers.