RN - Quality And Provider Education

Our Client, a Health Insurance company, is looking for a RN - Quality and Provider Education for their Grand Rapids, MI/ Hybrid location. Responsibilities: Provide comprehensive research and responses for identified problems and complex inquiries related to the provider community Conduct activities as assigned such as in-home Bone Mineral Density (BMD) testing on members Conduct in-state provider educational sessions in person and virtually on relevant topics such as new business tools, billing/coding, Health e-Blue (HeB), HEDIS, medical record reviews, etc. Perform clinical reviews with knowledge of clinical documentation, body systems, anatomy and physiology, preventative screening, etc. Scan records as required. Develop and maintain an effective, professional working relationship with providers and their staff Support providers in closing treatment opportunities (HEDIS/Star measures) Assist leaders in monitoring issues, projects, timelines, and plans related to various corporate initiatives impacting providers Research, analyze, identify, and evaluate data to assess existing trends and issues Recommend, communicate, and implement solutions to identified problems and root cause of issues Represent and participate in group discussions Assist other departments / consultants when visiting providers to discuss a variety of HEDIS/Star related topics Generate summary of activity monthly and as requested Requirements: Current unrestricted state of Michigan registered nurse license required Knowledge of quality improvement / process improvement / clinical guidelines Experience with MS Office skills. Excel is a plus Minimum three years of clinical experience Knowledgeable of NCQA HEDIS medical record review Bachelor’s degree in nursing Strong knowledge and experience in use of software (e.g., Excel, Outlook, PowerPoint, Word, etc.). Effective communication skills, written and verbal Experience in provider consulting/relations Strong analytical, organizational, planning, and problem-solving skills Ability to effectively interface with employees at all levels Ability to understand and apply statistical inference including research principles Demonstrated medical and clinical knowledge required to analyze related issues and apply principles to health care business environment. R.N. licensed in Michigan; BSN degree preferred. Associate degree acceptable with professional experience Why Should You Apply? Health Benefits Referral Program Excellent growth and advancement opportunities As an equal opportunity employer, ICONMA provides an employment environment that supports and encourages the abilities of all persons without regard to race, color, religion, gender, sexual orientation, gender identity or express, ethnicity, national origin, age, disability status, political affiliation, genetics, marital status, protected veteran status, or any other characteristic protected by federal, state, or local laws.