For Value-Based Care (VBC) programs within HOPCo Clinically Integrated Networks (CINs), promotes adherence to evidence-based best practices and quality assurance standards by conducting chart audits. Collaborates with physicians, patient/family, and VBC team members to assure patient management to efficiently align patient needs using resources to meet quality, clinical, and cost-effective outcomes within the CIN.

Benefits:

• Salary $28-38.00/hr DOE
• Competitive Health & Welfare Benefits
• HSA with qualifying HDHP plans with company match
• 401k plan after 6 months of service with company match (Part-time employees included)
• Employee Assistance Program that is available 24/7 to provide support
• Employee Appreciation Days
• Employee Wellness Events

ESSENTIAL FUNCTIONS

• Audit and analyze patient records to ensure adherence to clinical practices and protocols and appropriateness of services
• Provide reports on results obtained from audits and analysis to identify opportunities for improvement
• Investigate, analyze, and report questionable findings along with recommendations, to assist in identifying gaps in quality patient care
• Monitor the factors and trends that influence physician and network performance
• Support the Value-Based Care CMO and VBC team in enhancing Excellence Through Evidence-Based best practice program
• Complete all reporting requirements on time with data integrity, and in the requested format to ensure appropriate documentation
• Accept, receive, and manage Care Management referrals, who meet criteria, in a timely manner

• Collaborate with patients, families, physicians, and other healthcare team members in building consensus around issues and appropriately resolve promptly
• Provide education and coaching for specific population needs as required by the VBC Care Management program
• Communicate effectively and professionally with internal and external customers
• Ensure the patient is progressing toward desired outcomes by monitoring patient care through assessment and evaluation
• Ability to assess current operations, policies, systems, and procedures to develop and implement necessary and innovative changes
• Ability to manage protected health information (PHI) in a manner consistent with the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
• Perform related duties as assigned
• Perform other CIN duties as assigned

EXPERIENCE

• Licensed Registered Nurse (RN) required
• Bachelor’s degree in nursing preferred
• Minimum three (3) years of clinical nursing and/or Care Management experience is required
• Orthopedic experience required.
• Clinical review, utilization review, or quality assurance review experience preferred