RN - Health Care - Analysts

Job Description

Job Description In the Clinical Analyst (RN) role, you will provide clinical support for External Quality Review activities, including validation of Performance Improvement Projects (PIPs), compliance reviews, and focused studies and must have the ability to work independently with minimal supervision. The Clinical Analyst (RN) will communicate with State agencies, Managed Care Plan (MCP) quality and clinical staff, and other provider staff, as necessary. This individual may travel to health plans/physician practices/other providers in states for which IPRO serves as an External Quality Review Organization (EQRO). Duties will include, but are not limited to:

Conduct medical record and case file abstraction for focused clinical studies and special projects such as care management audits, nursing facility level-of-care audits, home- and community-based service plan audits, and others.

Participate in training and Internal Quality Control (IQC) for medical record reviews. Maintain productivity and accuracy.

Participate in review and validation of Performance Improvement Projects.

Provide information/data for the preparation of summary reports of review activities.

Validate MCP-reported data (e.g. HEDIS, QARR, encounter data) against medical records to support data audit and validation projects.

Participate in review of documents and conduct interviews for MCP compliance and readiness reviews. Reviews may be conducted virtually or onsite.

Conduct HEDIS/performance measure reviews.

This position is office based at our Jericho, NY or Albany, NY office.

QUALIFICATIONS:

Strong communication (written and verbal) skills.

Proficiency in PC-based computer software, especially Microsoft Office Suite products.

Ability to work independently with minimal supervision and as part of a team.

Ability to relate effectively with medical, technical, analytic and administrative personnel.

Ability to travel to on-site review assignments, both local and out of area/overnight travel.

Must have the ability to work flexible days and hours when necessary.

EDUCATION & EXPERIENCE:

Licensed RN and a graduate of an approved, registered, professional nurses’ training program, or licensed clinical social worker, required.

Bachelor’s degree in a related discipline (nursing, healthcare administration, health policy, etc.), required.

Minimum of two (2) years of related work experience required.

The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. The annualized salary range for this position is $75,000.00-$95,000.00. Actual salary range and/or hourly rate depends on a variety of factors including experience, education, credentials, location, and budget.

The salary range and/or hourly rate listed does not include other forms of compensation or benefits.

IPRO is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or military status, or any other category protected under applicable law.