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KYYBA Inc · 1 day ago

RN Review Analyst

Grand Rapids, MI

Full-time

Hybrid

Mid Level

3+ years exp

KYYBA Inc is seeking a Registered Nurse for their Quality and Provider Education department. The role primarily involves remote work with occasional onsite responsibilities, focusing on provider education, clinical reviews, and member health screenings.

AutomotiveConsultingStaffing Agency

No H1B

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

Qualification

Registered Nurse LicenseHEDISClinical ExperienceQuality Improvement KnowledgeMS Office SkillsAnalytical SkillsProvider Consulting ExperienceEffective CommunicationOrganizational SkillsProblem-Solving Skills

Required

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

Valid MI driver's license; willing to drive to provider locations and travel throughout Michigan as needed (no exceptions)

Have a dependable vehicle every workday and be willing to travel up to five days a week (varies dependent on time of year, however, travel tends to average mostly 1-3 days per week)

Minimum three years of clinical experience

R.N. licensed in Michigan; BSN degree preferred. Associate degree acceptable with professional experience