What are the responsibilities and job description for the Value Based Case Management Senior Analyst - RN - Philadelphia, PA position at CareAllies?
At CareAllies, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.
Job Summary
This position is responsible for coordinating and manage relationships with participating provider practices. Maintain detailed understanding of HEDIS / STAR performance measures. Develop and maintain a process to ensure all customers participating in provider practices meet all quality metrics. Responsible for coordinating the delivery of cost-effective, quality –based health care services for health plan customers by development and implementation of alternative treatment plans that address individual needs of the customer, their benefit plan, and community resources. Plans, implements, and evaluates appropriate health care services in conjunction with the physician treatment plan. Utilizes clinical skills to assess, plan, implement, implement, coordinates, monitor and evaluates options and services to facilitate appropriate healthcare outcomes for customers.
Required Job Qualifications
We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
Pay Transparency Statement
At CareAllies, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, a minimum of 15 days’ of paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for full-time employees.
The salary offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.
Min To Max Range
$67,000.00 - $121,100.00
Job Summary
This position is responsible for coordinating and manage relationships with participating provider practices. Maintain detailed understanding of HEDIS / STAR performance measures. Develop and maintain a process to ensure all customers participating in provider practices meet all quality metrics. Responsible for coordinating the delivery of cost-effective, quality –based health care services for health plan customers by development and implementation of alternative treatment plans that address individual needs of the customer, their benefit plan, and community resources. Plans, implements, and evaluates appropriate health care services in conjunction with the physician treatment plan. Utilizes clinical skills to assess, plan, implement, implement, coordinates, monitor and evaluates options and services to facilitate appropriate healthcare outcomes for customers.
Required Job Qualifications
- Current Licensure as a registered nurse, in the state of residence in good standing.
- Associates degree, diploma, or B.S. in Nursing
- Three to Five (3-5) years recent experience in an acute-care environment, case-management, or utilization management position (experience can be a combination of LVN/RN licensure)
- Previous HEDIS and/or CMS STARs experience a plus.
- Bilingual (English/Spanish)
- Previous HEDIS and/or CMS STARs experience
- Strong proficiency level using Microsoft Excel
- Client-site Location: This is a field based position in the Philadelphia, PA market, including surrounding cities. The individual will be onsite at provider offices 3-5 times weekly.
- Schedule: Monday - Friday, typical business hours
- Sponsorship: Sponsorship is not available
We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
Pay Transparency Statement
At CareAllies, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, a minimum of 15 days’ of paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for full-time employees.
The salary offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.
Min To Max Range
$67,000.00 - $121,100.00
Salary : $67,000 - $121,100
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