Quality Performance Specialist Clinical, Registered Nurse
- Relevante, Inc.
- Washington, DC, 20020
Posted on
Job Description:
We have partnered with a large Health Insurance company in the Washington, DC area to provide them with a Quality Performance Specialist Clinical, RN.
Please review the below description and if you are interested please contact:
- Phanish Adivi at padivi@relevante.com, 484-403-4161
Job Summary:
Responsibilities:
This position is responsible for leading and coordinating the clinical quality review process of member concerns and medical records utilizing of care standards. In addition, responsibilities also include supporting the annual medical record review activities including HEDIS and, Clinical Practice Guidelines. The position also supports accreditation and clinical quality performance improvement activities.
Education/Experience:
- Required Registered Nurse with current and valid licensure in Washington DC.
- Required Proficient with Microsoft Office applications including Word, PowerPoint, Excel.
- Required 3-5 years quality improvement experience.
- Preferred CPHQ.
- Preferred knowledge and understanding of QI functions in an MCO .
- Preferred knowledge of Medicaid.
- 2-4 years experience in project facilitation/management role.
- 3 –5 years Managed Care experience.
Company Description:
About Us
Relevante is an innovative recruiting, staffing, and consulting firm. We help our clients find the best talent for their mission-critical positions and we help candidates find rewarding and enriching careers. Our consultative approach to solving resourcing challenges for our clients is driven by our industry-specific knowledge, our strong recruiting capabilities, and our agility.
We support our clients’ goals through results-driven execution, planning, and management of accounting and technology initiatives. Relevante’s resourceful and responsive teams bring deep technology and accounting expertise, thought leadership, and business-relevant solutions to each and every partnership. Our clients appreciate we can do attitude, value our results, and keep coming back.
Founded in 2002, we have grown through a culture of operational excellence, a passion for client satisfaction, technology innovation, and a global, collaborative workforce that embodies the future of work. Our success is built on a clear strategic direction and a shared belief in its ability to shape your business landscape and accelerate business growth.