RN, Quality - Part-Time

About the position The RN, Quality - Part-Time position at VIVA HEALTH involves ensuring compliance with quality improvement activities related to healthcare services. This role focuses on enhancing member outcomes and maintaining high STAR ratings as recognized by the Centers for Medicare & Medicaid Services (CMS). The position requires a combination of remote work and occasional in-office presence, along with travel to various locations within the service area. Responsibilities • Perform medical record and claims information reviews in compliance with quality measure specifications (HEDIS chart abstraction). , • Collaborate with internal departments to perform member outreach and engage physician and physician office staff to improve member outcomes. , • Review potential quality of care grievances and track and trend providers/facilities, reporting outcomes. , • Support member and provider interactions by assisting member access to necessary services, performing routine screenings, and facilitating community health fairs and wellness events. , • Monitor regulatory guidelines published by CMS, OSHA, NCQA, and others relevant to areas of responsibility. Requirements • Graduate of an accredited program of professional nursing, ADN/BSN , • 1 year experience in a health care quality management/improvement related function , • Current RN License in good standing with the State of Alabama Board of Nursing , • Valid driver's license in good standing , • CPR Certification , • Knowledge of medical conditions, treatment, documentation, and practice standards , • Ability to organize ideas and communicate written and oral messages appropriate to listeners and situations , • Ability to develop project plans, problem solve, and engage others to achieve department and company strategic goals , • Ability to think analytically with demonstrated skills in interpreting health care data and medical information , • Ability to work under pressure to meet deadlines with minimal supervision , • Skilled at communicating and interacting professionally and courteously with a diverse population , • Skilled use of personal computers and related software such as Microsoft Office suite. Nice-to-haves • Bachelor's degree in nursing or other health-related field , • Experience in Managed Care , • Experience in a community-based clinical role such as home health , • Experience in HEDIS chart abstraction and data management tools , • Working knowledge of health care coding and insurance , • Ability to perform data analysis using a variety of systems and databases , • Knowledge and understanding of Medicare Advantage STARs rating components especially HEDIS , • Knowledge of risk assessment and writing policies and procedures , • Skilled at medical chart review and assessment of compliance with established standards. Benefits • Flexible work schedule with hybrid remote work options , • Opportunity to work with a high-performing health plan , • Engagement in community health initiatives , • Professional development opportunities through UAB Health System Apply Job!