Senior Provider Engagement Clinical Professional

Profile

Description

The Senior Provider Engagement, Clinical Professional develops and grows positive, long-term relationships with physicians, providers and healthcare systems in order to support and improve financial and quality performance within the contracted working relationship with the health plan. The Senior Provider Engagement, Clinical Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

The Senior Provider Engagement, Clinical Professional represents the scope of health plan/provider relationship across such areas as financial performance, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance, operational improvements and other areas as they relate to provider performance, member experience, market growth, provider experience and operational excellence. This work focuses on areas of clinical emphasis. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, andwork is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

Required Qualifications


Bachelors or Associates Degree in Nursing
Registered Nurse license unrestricted in the state of Tennessee, Alabama or Virginia
5 years clinical work experience as an RN
Excellent communication and organizational skills
Ability to work independently
Self-motivated
Working knowledge of Microsoft Office: Word, Excel, PowerPoint


Preferred Qualifications


3-5 years of managed care experience
3-5 years of case management experience
Knowledge of HEDIS measures
Experience with CMS Medicare Advantage Star Ratings program


Additional Information


This position is virtual and work at home
Must be comfortable communicating virtually with providers and members
Ideal candidate will reside in Tennessee, Alabama or southwest Virginia and have the ability to travel to Knoxville, TN for mandatory meetings


Scheduled Weekly Hours

40

Company info

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