Registered Nurse – Quality Improvement (Finance)

Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.

By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.

Position Summary:
This position will help lead in analytical projects in AHC's Quality Improvement Medicare Stars team and will be responsible for conducting effectiveness studies on various program/ campaigns to improve Stars Rating. The individual will help contribute with chart reviews, coding initiatives, patient outreach and overall Hedis support for all plan contracts throughout the year.

General Duties/Responsibilities:

(May include but are not limited to)

• Conduct patient outreach.
• Collaborates with the Stars team, the PCP and/or the market leader on data analysis.
• Perform medication review and reconciliation, as well as exclusion work around all Hedis measures.
• Interprets and evaluates Hedis data and participates in solutions for reconciliation and gaps.
• Educates members on Hedis if necessary.
• Performs chart reviews for missed opportunities.
• Use of Electronic Medical Records required.

Minimum Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Minimum Experience:
   1. Knowledge of clinical standards of care
   2. Minimum 1 year experience as an RN

1. Education/Licensure:
   1. Requires successful completion of an accredited Nursing Program; BSN preferred, Registered Nurse preferred, LVN considered with appropriate experience
   2. Current, unrestricted license in the state for which you are applying
   3. Must have valid driver's license and automobile insurance
2. Other:
   1. Experience in Medicare Stars Program with an emphasis in Hedis Part C and Part D measures.
   2. Knowledge of Medicare Managed Care Plans, preferred
   3. Excellent administrative, organizational and verbal skills
   4. Effective communication skills with seniors
   5. Computer literate and able to navigate the internet
   6. Ability to work independently
   7. Detail oriented
   8. Dependable and reliable
   9. EMR experience is strongly preferred
   10. Bilingual skills valued (Spanish preferred)
3. Work Environment:

1. 1. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Pay range: $90,000-100,000

FLSA Status: Exempt

Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.

If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact careers@ahcusa.com .