Remote Utilization Review Rn Jobs in West Columbia, SC

Alliant Health Solutions, a "Best Place to Work" and "Healthiest Employer", seeks a Clinical Quality Advisor

POSITION SUMMARY

In accordance with customer contractual requirements, the Clinical Quality Advisor, Opioid Prescriber Support (OPS) will support prescribers participating in the OPS program. The Clinical Quality Advisor, OPS will provide technical assistance and provide education to opioid outlier prescribers about evidence based best practices and quality improvement to improve patient outcomes.

ESSENTIAL JOB FUNCTIONS

• Engage clinicians to decrease opioid prescriptions as directed by CMS.
• Engage and collaborate with healthcare systems, community leaders, and other personnel as applicable.
• Lead, guide, and provide customer account management for the use of the quality improvement methodology, implementation science, healthcare facilitation, intervention effectiveness, behavioral science, and other Alliant-adopted strategies to understand, measure, and predict contract performance through timely and effective measures.
• Work closely with clinical subject matter experts to provide innovative outreach and engagement to prescribers.
• Follow standard operating procedures (SOPs) for all quality improvement activities, maintaining compliance with established timelines and project milestones.
• Practice and promote rapid cycle improvement techniques in daily work.
• Track, monitor and enter timely data entry (within 24 hours) within designated Alliant Customer Relationship Management (CRM) or CMS system(s) to document technical assistance encounters.

OTHER JOB FUNCTIONS

• Behaves in a customer–service-oriented and positive manner with internal and external customers, at all levels of the organization.
• Ensure quality work and always improve work product and services.
• Adhere to department and company policies and procedures, and compliance programs.
• Promote core values of teamwork, professionalism, effective communication skills, and positive behaviors. 
• Maintain security and confidentiality of all information in accordance with HIPAA laws and regulations and company policies. 
• Other tasks, projects, and duties as assigned.

KNOWLEDGE, SKILLS, AND ABILITIES

• Knowledge, skill, and ability to work independently and organize and prioritize time and projects; and manage and collaborate with team
• Knowledge, skill, and ability to manage and adapt to change, and be flexible in work assignments.
• Computer literate with keyboarding skills and intermediate to advance level knowledge of Microsoft Office (including Word, PowerPoint, Excel, Outlook, Teams), Internet, and virtual meeting platforms such as Zoom.
• Proven ability and experience in engaging and building strategic relationships with internal and external customers.
• Ability to express ideas and convey information quickly and effectively in a verbal and written manner.
• Ability to think creatively and critically, and analyze problems, and find innovative approaches to problem resolution.
• Ability to handle multiple projects simultaneously
• Ability to maintain confidential information.
• Ability to travel as required by driving and/or going on airplane to home office, customer locations, or other required locations to provide technical assistance, meetings etc.

EDUCATION, EXPERIENCE, AND TRAINING

Required:

• Registered Nurse, with at least three years of recent clinical experience
• Bachelor’s degree in nursing or other related field required; or equivalent work experience
• Current and unencumbered nursing license in state of resident or multi-state license

Previous quality improvement work experience in hospitals, nursing homes, and/or physician practices

PHYSICIAL REQUIREMENTS

Essential duties are routinely performed in a professional office environment but may be conducted in remote or field locations. The role may require work at a station/desk and routinely requires use of standard office equipment such as computers, phones, photocopiers/scanners, fax machines, printers, and filing cabinets. Duties may require use of transportation to attend meetings or conduct duties outside of the office environment. Must be able to regularly remain in a stationary position and occasionally move about the office to access office machinery and facilities. Occasionally must be able to move/transport materials weighing up to 30 pounds, as well as position self to access files, equipment and work materials. This role frequently communicates to internal and external resources both verbally and written, via face-to- face, electronic and telephonic media. Must be able to understand and exchange accurate information in these situations, as well as translate into action. Short-term and long-term memory, abstract reasoning and decision making may be required on a regular basis. Core office / business operational hours may be required.

ADA/ADAAA/SECTION 503 NOTIFICATION

In compliance with the ADA, the ADA Amendments Act (ADAAA) and Section 503 of the Rehabilitation Act), should you have a disability and would like to request reasonable accommodation, please see Human Resources to begin the interactive process.

DISCLAIMER

This job description indicates the general nature and level of work expected of the incumbent. It is designed to cover or contain a comprehensive, but not all-inclusive, listing of activities, duties, tasks and/or responsibilities as required for Employee. Employee may be asked to perform other duties and responsibilities as required.