SL
Sr. Clinical Dental Consultant at DentaQuest reviewing claims based on medical necessity, evaluating appeals, and providing clinical aid for provider outreach. Focused on improving oral health access and quality care.
About the role
- responsible for the development, implementation and management oversight of the company's Medicare Stars Program in the Florida region
- Develops programs designed to increase the plan quality
- Medical records reviews, EMR remote provider gap closure support will be 30% of role
- 30% of role is participating in Stars new pilot strategies that will support Humana provider specific measure care gap closure
- 40% will include provider in person visits
- Partners with leaders regarding implementation planning
- Reviews and communicates results of programs
- Provider non-standard supplemental data trending
- Provider level HEDIS in service
- Develop and implement measure specific strategies
- Provider and Member outreach on focused care gap measures
- EMR remote strategy for Humana provider care gap closure on targeted measures
- Provider office in person, Zoom virtual or telephonic meetings
- Weekly metrics for provider outreach may apply, some Zoom telephonic outreach will entail cold calling to the in-network providers to establish working relationships
- Quality/clinical management and population health HEDIS and Stars performance
- Operational improvements
- Financial performance and incentive programs
- Data sharing and connectivity, interoperability opportunities
- Documentation and coding
- Additional areas related to provider performance, member experience, market growth, provider experience and operational excellence
Requirements
- Licensed Registered Nurse (RN) without restriction in Florida
- 5 or more years of clinical nursing experience
- 1 or more years of in electronic medical records systems and Medical Records auditing experience, in the past 5 years
- 1 or more years of provider office and/ or clinic management experience, in the past 5 years
- 1 or more years' experience visiting providers or members
- Comprehensive knowledge of Microsoft Office applications, Word and Excel with advanced knowledge of PowerPoint
- Excellent presentation and communication skills, both oral and written
- Strong relationship building skills as this is a provider-facing role
- Strong attention to detail with a focus on process and quality
- Valid driver's license with reliable transportation and the ability to travel up to 40% within the region
Benefits
- medical, dental and vision benefits
- 401(k) retirement savings plan
- time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
- short-term and long-term disability
- life insurance and many other opportunities
Job title
Job type
Experience level
Salary
Degree requirement
Location requirements
HS
Hypoport SECorporate Finance Consultant – m/f/d
Consultant for corporate financing specializing in complex funding and financing solutions in Germany. Engaging with clients to develop and implement financing concepts and strategies.
CL
Canada LifeRehabilitation Consultant
Rehabilitation Consultant focusing on managing complex disability cases and supporting return to employability. Working in Calgary, AB with a customer - focused approach for rehabilitation services.
SG
Serviceplan GroupSenior Consultant
Senior Consultant developing communication and positioning strategies for clients at the intersection of politics, economics, and society. Leading projects and advising on political developments in a highly interdisciplinary team.
Managed Services Manager at Huron overseeing managed services delivery for Oracle PPM, managing client relationships and ensuring service quality. Aiming for operational excellence and customer satisfaction.
CL
CLEAResultDemand Response Program Consultant
Demand Response Program Consultant leading energy efficiency programs in PA. Overseeing subcontractors, utility clients, and ensuring compliance with regulatory requirements.
BG
Babcock International GroupPrincipal Environmental Consultant
Principal Environmental Consultant at Cavendish Nuclear shaping sustainable solutions for nuclear waste management. Leading integrated waste management strategies and mentoring team members in a hybrid role.
BG
Babcock International GroupSenior Environmental Consultant
Senior Environmental Consultant delivering technical activities related to nuclear waste management and advancing in a consultancy environment. Focusing on stakeholder engagement and strategic project delivery.
National Junior Consultant providing support to UNESCO's education programs in Bangladesh. Assisting in multiple key activities including teacher training and program development.
EP
EvoluServices Meios de PagamentoConsultor de Relacionamento, Júnior
Junior Relationship Consultant at Evoluservices managing healthcare finance client portfolios, supporting retention and engagement strategies.