RN-Network Performance Improvement Consultant-Grand Rapids-BCN

<p>With more than 7,000 employees, we are the largest health insurance company in Michigan. We offer an exciting work environment with a diverse group of employees. Our goal is to make health insurance easier for our members. We want to transform the industry and become a resource that people can trust.</p>

Grand Rapids, MI

Blue Cross Blue Shield of Michigan

When you think of <a href="https://www.bcbsm.com/" target="_blank" rel="noopener noreferrer">Blue Cross Blue Shield of Michigan</a> for health insurance, you can know you&rsquo;re getting much more. We're a company founded on a tradition of affordable, quality health care for everyone, improving the present and investing in the future.<br /><br />We offer:<br />Plans for employers and individuals that meet today&rsquo;s needs, budgets and lifestyle<br />The largest network of doctors and hospitals in the state<br />Lower health care costs Higher quality health care<br />Award-winning diversity practices<br />Grants and programs that promote better health throughout Michigan<br /><strong><br />Mission:&nbsp;</strong>We commit to being our members&rsquo; trusted partner by providing affordable, innovative products that improve their care and health.<br /><br /><a href="http://www.bcbsm.com/index/about-us/our-company.html" target="_blank" rel="noopener noreferrer"><strong>Click here</strong></a> to learn more about our commitment to our Social Mission, view company updates and reviews, and view our awards &amp; accolades.<br /><br />Learn more about your options as an external candidate. <a href="https://bcbsm.taleo.net/careersection/2/jobsearch.ftl?lang=en" target="_blank" rel="noopener noreferrer">Click here</a> to view open positions. http://www.bcbsm.com

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Competitive Total Compensation Package

Overview: Blue Care Network of Michigan is seeking an RN who will provide analysis and sharing of clinical utilization, financial and quality trends with provider group administrators, medical directors, physicians and clinical leaders, identifies opportunities to improve clinical utilization and quality trends, develops strategy plans to implement interventions, works collaboratively with the groups to track and trend outcomes, and adjust strategies. Coordinates activities via a team approach with external and internal staff.
Responsibilities: <span style="font-size: small;">Meets with targeted providers, provider groups, group administrators, and specialists to obtain commitment for improvement initiatives, and to develop &amp; implement strategy plans.&nbsp; Meets regularly for assessment of outcomes and provide ongoing evaluation of strategy. Analyzes and prepares utilization, financial, quality and clinical-related reports to identify opportunities for improvement for targeted provider groups.&nbsp; Performs ad-hoc analysis when requested. Works with internal team to provide necessary tools, education and resources to provider</span>&nbsp;<span style="font-size: small;">groups. Provides input on design of internal reports (i.e.: PCP and specialist profiling) for ongoing development. Reports periodically on progress of provider group progress. Represents the department on multiple internal committees and workgroups.</span>&nbsp;<span style="font-size: small;">Facilitates internal team meetings to identify provider groups for clinical improvement focus. Other duties, projects as assigned.</span>
Requirements: <ul> <li>Registered nurse with unrestricted current Michigan license required.</li> <li>Bachelor&rsquo;s degree required. Master&rsquo;s degree preferred.</li> <li>Four (4) years of administrative or clinical experience in a health care related field required.</li> <li>Experience in leading and managing projects required.</li> <li>Experience with making presentations to individuals and groups.</li> <li>Demonstrated knowledge of managed care principles, case management, quality management, and disease management programs, claims processing and medical coding principles required.</li> <li>Utilization management knowledge and skills required.</li> <li>Excellent analytical skills and experience in assessing clinical utilization reports required.</li> <li>Knowledge of managed care financial risk models and reimbursement methodologies required.</li> <li>Excellent interpersonal skills including the ability to interact well with internal and external customers, especially administrative and clinical leaders required.</li> <li>Excellent verbal and written communication skills including the ability to conduct presentations with internal and external customers (including administrative and clinical leaders) required.</li> <li>Excellent statistical and analytical skills required.</li> <li>Knowledge of continuous quality improvement principles and processes required.</li> <li>Excellent organizational skills including the ability to handle multiple projects and timelines required.</li> <li>Ability to work effectively independently and in a team environment required.</li> <li>Intermediate knowledge of Microsoft Word, Excel, PowerPoint and Access preferred.</li> </ul> <span style="text-decoration: underline;"><strong>DEPARTMENT REQUIREMENTS:</strong></span><br /> <ul> <li>Demonstrated knowledge and experience working with HEDIS required.</li> <li>Demonstrated ability to review and understand patient medical records.</li> <li>Demonstrated ability to conduct audits on diagnosis coding, procedure codes, and medical office process flows.</li> <li>Excellent verbal and written communication skills to provide analysis and sharing of clinical utilization, financial and quality trends with provider group administrators, medical directors, physicians and clinical leaders.</li> <li>Demonstrated ability to build necessary medical office process flows and monitor them accordingly.</li> <li>Demonstrated ability to build collaboration and relationships.</li> <li>Excellent communication skills in order to discuss HEDIS scores with Provider offices.</li> <li>Experience in project management leading and managing projects.</li> <li>Requires valid, non-restricted driver's license for statewide travel with some overnight stays.</li> </ul>