RN Clinical Quality Analyst – Case Management | Remote | EXL Service

Job title: RN Clinical Quality Analyst – Case Management | Remote

Company: EXL Service

Job description: Company Overview and CultureEXL (NASDAQ: EXLS) is a global analytics and digital solutions company that partners with clients to improve business outcomes and unlock growth. Bringing together deep domain expertise with robust data, powerful analytics, cloud, and AI, we create agile, scalable solutions and execute complex operations for the world’s leading corporations in industries including insurance, healthcare, banking and financial services, media, and retail, among others. Focused on creating value from data for driving faster decision-making and transforming operating models, EXL was founded on the core values of innovation, collaboration, excellence, integrity and respect. Headquartered in New York, our team is over 40,000 strong, with more than 50 offices spanning six continents. For information, visit .For the past 20 years, EXL has worked as a strategic partner and won awards in its approach to helping its clients solve business challenges such as digital transformation, improving customer experience, streamlining business operations, taking products to market faster, improving corporate finance, building models to become compliant more quickly with new regulations, turning volumes of data into business opportunities, creating new channels for growth and better adapting to change. The business operates within four business units: Insurance, Health, Analytics, and Emerging businesses.About EXL HealthWe leverage Human Ingenuity and domain expertise to help clients improve outcomes, optimize revenue and maximize profitability across the healthcare ecosystem. Technology, data and analytics are at the heart of our solutions. We collaborate closely with clients to transform how care is delivered, managed and paid.EXL Health combines deep domain expertise with analytic insights and technology-enabled services to transform how care is delivered, managed, and paid. Leveraging Human Ingenuity, we collaborate with our clients to solve complex problems and enhance their performance with nimble, scalable solutions. With data on more than 260 million lives, we work with hundreds of organizations across the healthcare ecosystem.We help payers improve member care quality and network performance, manage population risk, and optimize revenue while decreasing administrative waste and reducing health claim expenditures. We help Pharmacy Benefit Managers (PBMs) manage member drug benefits and reduce drug spending while maintaining quality. We help provider organizations proactively manage risk, improve outcomes, and optimize network performance. We provide Life Sciences companies with enriched data, insights through advanced analytics and data visualization tools to get the right treatment to the right patient at the right time.The Registered Nurse Clinical Quality Analyst – Case Management (CM) plays a key role in ensuring our case management program meets high-quality standards. This Analyst is responsible for monitoring staff performance, identifying opportunities for improvement, and ensuring we comply with all accreditation and regulatory requirements. By coordinating and conducting case review audits, they provide valuable feedback to both clinical and non-clinical staff. As a quality expert, the CM Clinical Quality Analyst collaborates with the leadership team to analyze data, identify trends, and compile reports, making recommendations for process improvements to enhance our program’s effectiveness.Responsibilities:

• Collaborate with management team to develop or adapt audit tools and reports as needed to effectively conduct, document, and communicate audit activities.
• Develop standardized auditing process and schedule consistent with department policy.
• Conduct routine case review audits to identify and address opportunities for improvement.
• Analyze, track, and trend staff audit results; prepare written feedback for manager to assist with performance improvement and staff development.
• Analyze individual, team, and department trends based on monitoring results and provide recommendations to leadership team.
• Perform quality monitoring (trending and analysis) of CM program performance metrics and outcome measures. Summarize quality monitoring findings, analyze root causes, and propose quality improvement plans as appropriate.
• Develop CM program quality monitoring reports and present to the Case Management Quality Improvement Committee (CMQIC) for input and direction.
• Analyze satisfaction survey results and case management complaints to identify opportunities to improve beneficiary experience with the case management program and summarize results for CMQIC.
• Actively identify and make recommendations on ideas to improve the quality effectiveness and efficiency of departmental functions; meet regularly with management team to review issues and proposed solutions to gain commitment on recommendations.
• Work with operational teams to monitor the effectiveness and efficiency of any process changes made for quality improvement.
• Identify gaps in performance requiring additional training and collaborate with CM Trainer to develop mitigation plan.
• Evaluate current processes, compare to relevant accreditation standards and standards of practice, and identify gaps in compliance or performance, and recommend improvements.
• Prioritizes and executes performance improvement plans related to clinical performance.
• Participates in the development and distribution of accreditation best practices; organizes and participates in readiness assessments in preparation for accreditation survey submissions.
• Provide expert consultation to team on quality improvement processes and performance improvement methodologies.

QualificationsRequired:

• 3+ years of clinical RN experience in in a clinical role with responsibilities for direct patient care
• 3+ years managing performance improvement or quality improvement projects required
• Experience working in an NCQA accredited Case Management program required
• Bachelor’s degree in nursing from an accredited college, university, or school of nursing required
• Current, unrestricted RN license in the state of residence and ability to obtain multi-state licensure required
• Ability to obtain Security Clearance required. Current DOD Security Clearance preferred
• Must hold United States citizenship status

Preferred:

• Experience as a case manager at a health plan highly desirable
• Case Management Certification highly desirable (CCM preferred)
• Clinical quality certification highly desirable (CPHQ preferred)
• Experience as a telephonic case manager at a health plan highly desirable
• Ability to apply continuous quality improvement concepts and methodologies to effectively monitor, assess, and communicate effectiveness of case management processes
• Strong and highly effective communication skills (verbal, written, presentation, interpersonal)
• Strong systems-oriented analytical, organizational, critical thinking, and analysis skills
• Proficient in Microsoft Office product suite (Word, Excel, PowerPoint, Outlook, Teams and shared folders)
• Knowledgeable in compiling, organizing, and analyzing data and proficiency with technology, spreadsheet analysis, reporting and graphing tools
• Ability to work effectively in a cross-functional team environment and adapt to changing program or organizational priorities
• Ability to manage multiple simultaneous work demands remotely in an effective and professional manner; ability to reset priorities to meet deadlines
• Knowledge of payor issues, provider network issues, and case management initiatives
• Knowledge of case management industry best-practices, patient-centered care concepts, current professional standards of case management, and accreditation standards
• Experience with or strong working knowledge of NCQA Case Management accreditation standards

What We Offer:

• EXL Health offers an exciting, fast paced, and innovative environment, which brings together a group of sharp and entrepreneurial professionals who are eager to influence business decisions.
• From your very first day, you get an opportunity to work closely with highly experienced, world class Healthcare consultants.
• You can expect to learn many aspects of businesses that our clients engage in. You will also learn effective teamwork and time-management skills – key aspects for personal and professional growth.
• We provide guidance/ coaching to every employee through our mentoring program wherein every junior level employee is assigned a senior level professional as advisors.
• Sky is the limit for our team members. The unique experiences gathered at EXL Health sets the stage for further growth and development in our company and beyond.

EEO/Minorities/Females/Vets/DisabilitiesTo view our total rewards offered click here —Base Salary Range Disclaimer: The base salary range represents the low and high end of the EXL base salary range for this position. Actual salaries will vary depending on factors including but not limited to: location and experience. The base salary range listed is just one component of EXL’s total compensation package for employees. Other rewards may include bonuses, as well as a Paid Time Off policy, and many region specific benefits.Please also note that the data shared through the job application will be stored and processed by EXL in accordance with the EXL Privacy Policy.
Application & Interview Impersonation Warning – Purposely impersonating another individual when applying and / or participating in an interview in order to obtain employment with EXL Service Holdings, Inc. (the “Company”) for yourself or for the other individual is a crime. We have implemented measures to deter and to uncover such unlawful conduct. If the Company identifies such fraudulent conduct, it will result in, as applicable, the application being rejected, an offer (if made) being rescinded, or termination of employment as well as possible legal action against the impersonator(s).
EXL may use artificial intelligence to create insights on how your candidate information matches the requirements of the job for which you applied. While AI may be used in the recruiting process, all final decisions in the recruiting and hiring process will be taken by the recruiting and hiring teams after considering a candidate’s full profile. As a candidate, you can choose to opt out of this artificial intelligence screening process. Your decision to opt out will not negatively impact your opportunity for employment with EXL.

Expected salary: $75000 per year

Location: USA

Job date: Wed, 17 Jul 2024 01:16:49 GMT

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