16 Healthmap Solutions Claims Adjuster Jobs Hiring Near You

Position Summary

The Quality Practice Advisor is responsible for coordinating performance improvement activities to engage, educate, and manage activities to improve the health outcomes of Healthmap Solutions members. This position will closely partner with the Care Navigation team to improve the quality of the Kidney Health Management clinical program. 
Responsibilities 

• Develop a trusting partnership with clinical providers and practice locations
  
• Identify opportunities to improve health outcomes for Healthmap Solutions members based on provider specific data
  
• Incorporate education and communication on Best Practice sharing for identified areas of provider low performance
  
• Provide assistance in identifying areas for process improvement in provider office workflows
  
• Partner with physicians/physician staff to identify Healthmap Solutions members that would benefit from Care Navigation support
  
• Support operational and clinical stakeholders in the identification, development, and execution of process improvement initiatives
  
• Improve provider performance in areas such as Healthmap Solutions Interventions, Care Gaps, and Chronic Conditions
  
• Educate providers on HEDIS measures and open Care Gaps
  
• Support the development and implementation of quality improvement interventions
  
• Identify opportunities to educate provider offices on topics related to Chronic Kidney Disease, End Stage Renal Disease, Renal Replacement Therapies, etc.
  
• Build strong cross-functional relationships with internal departments and provider partners and practice staff
  
• Collaborate with the Care Navigation team to provide and receive information to enhance care coordination on Healthmap Solutions members
  
• Maintain thorough documentation of all provider meetings and interactions for consistency and coordination of provider engagement
  
• Maintain documentation in compliance with National Committee for Quality Assurance (NCQA) standards
  
• Ensure timely and successful delivery of reports to internal and external stakeholders
  
• Perform other related duties as assigned

Requirements 

• Bachelor’s degree required
• Active, unrestricted, RN license required
• Basic Life Support (BLS) certification required for all field roles (within 30 days of hire)
• 3 years of experience in a health care or managed care setting
  
• 3 years of experience in claims or gap closure campaigns, preferred
  
• 3+ years of progressive experience in healthcare services, clinical operations, quality, or care management
  
• Prior experience building and managing relationships with health care providers preferred
  
• Proof of valid and unrestricted driver’s license required and automobile insurance as required by law; this position requires regular travel within assigned region to support practices and or other healthcare/clinical sites as needed
  
• Same state residency required

• Current Tuberculosis (TB) test or current chest X-ray
• Proof of immunizations (e.g., Hepatitis B, MMR, Varicella, COVID-19, Influenza)
• Participation in annual health and wellness screenings

Skills
 

• Excellent verbal, written and presentation, skills
  
• Interpersonal skills to develop and maintain strong internal and external relationships
  
• Ability to multitask, prioritization, and create solutions in a fast-paced environment
  
• Strong critical thinking and analytical skills
  
• Must be proficient in Microsoft Office: Outlook, Word, Excel, PowerPoint

Travel

Heavy Travel, over 50%, to support practices in an assigned geographic market.

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