Texas Licensed Clinical Quality RN
A company is looking for an RN Clinical Quality/Primary Source Verification Compact Licensure. Key Responsibilities Complete Supplemental Data Source (SDS), Primary Source Verification (PSV), and Over-read tasks to achieve high productivity and improve STAR ratings Serve as a subject matter expert on HEDIS Measures and related tools, and be the primary contact for STAR activities in assigned markets Assist in developing training materials and identify barriers to achieving targeted outcomes within provider groups Required Qualifications Bachelor of Science in Nursing, Healthcare Administration, or related field required (or equivalent work experience) Registered Nurse with a current license in Texas or other participating states 5+ years of healthcare experience, including managed care, hospital, or physician practice settings 3+ years of managed care experience, with at least two years in Utilization Management Knowledge of CMS and/or NCQA standards, and proficiency with Microsoft Office applications
A company is looking for an RN Clinical Quality/Primary Source Verification Compact Licensure.
Key Responsibilities
Complete Supplemental Data Source (SDS), Primary Source Verification (PSV), and Over-read tasks to achieve high productivity and improve STAR ratings
Serve as a subject matter expert on HEDIS Measures and related tools, and be the primary contact for STAR activities in assigned markets
Assist in developing training materials and identify barriers to achieving targeted outcomes within provider groups
Required Qualifications
Bachelor of Science in Nursing, Healthcare Administration, or related field required (or equivalent work experience)
Registered Nurse with a current license in Texas or other participating states
5+ years of healthcare experience, including managed care, hospital, or physician practice settings
3+ years of managed care experience, with at least two years in Utilization Management
Knowledge of CMS and/or NCQA standards, and proficiency with Microsoft Office applications
