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Grievance Nurse

Lumeris

Grievance Nurse

Saint Louis, MO
Full Time
Paid
  • Responsibilities

    Grievance Nurse St. Louis, MO/en-US/LC/job/St-Louis-MO/Grievance-Nurse_R0002065/apply In order to apply for a position at Lumeris, you must create an account using your email address and a password of your choosing. This account will allow you to receive notifications each step of the way through the job application process. With these updates, youll never have to wonder where you are in the process. Additionally, we can easily send pertinent documents to you for your review. Once you create the account, you may apply to any position you feel is a good fit without having to re-enter information. Thank you for your interest in Lumeris. Position: Grievance Nurse Position Summary: The Quality Improvement Nurse is responsible for investigation, monitoring and reporting of Quality of Care, Quality of Service and Serious Reportable Adverse Events according to Center for Medicare and Medicaid Services (CMS) guidelines and plan policies and procedures. The Quality Improvement Registered Nurse will complete medical record reviews for re-credentialing, assist with inter rater reliability in conjunction with the HEDIS Medical Record Review Project and support activities related to Quality Improvement initiatives. Job Description: Roles and Responsibilities: * Conducts review of member grievances related to Quality of Care and Quality of service issues.nbsp; * Prepares reports to support CMS reporting requirements for quality topics such as Serious Reportable Adverse Events. * Conducts medical record reviews to support regulatory requirements for the purposes of re-credentialing, HEDIS, Star Ratings and Medicare quality indicator reporting as needed. * Extract, collect, analyze and summarize performance data for quality of care issues, quality initiatives, HEDIS, surveys, and audits. nbsp; * Participates in Quality Improvement initiatives. * Performs other duties as assigned. Experience, Qualifications, and Education: * RN or LPN required * Bachelors Degree in a health related field * 2+ years of experience in Quality Improvement * 2+ years of experience in Managed Care * 2+ years experience with regulatory-required initiatives (e.g., HEDIS, CAHPS) * Proficiency with clinical data management and statistical quality tools * Proficiency with MS Office applications * Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action * Excellent verbal and written communication skills Lumeris is an EEO/AA employer M/F/V/D. Location: St. Louis, MO Time Type: Full time Status: XL - FTPosted YesterdayFull timeR0002065 Join Our Growing Team! Lumeris serves as a long-term operating partner for organizations that are committed to the transition from volume- to value-based care and delivering extraordinary clinical and financial outcomes. Lumeris enables clients to profitably achieve greater results through proven playbooks based on collaboration, transparent data and innovative engagement methodologies. Lumeris offers comprehensive services for managing all types of populations, including launching new Medicare Advantage Health Plans, Commercial and Government Health Plan Optimization, and Multi-Payer, Multi-Population Health Services Organizations (PHSOs). Currently, Lumeris is engaged with health systems, provider alliances and payers representing tens of millions of lives moving to value-based care. Over the past seven years, we have tripled in size to more than 800 employees and built the only solution on the market with our proven outcomes. For the past six years, Essence Healthcare, a long-standing Lumeris client, has received 4.5 Stars or higher from the Centers for Medicare and Medicaid Services (CMS). Essence Healthcare was Lumeris pioneer client and has been leveraging Lumeris for more than a decade to operate its Medicare Advantage plans, which serve more than 60,000 Medicare beneficiaries in various counties throughout Missouri and southern Illinois. In 2018, Lumeris was named Best in KLAS for Value-Based Care Managed Services in the area of client-reported impact on the Triple Aim by KLAS Research. This was the third year in a row Lumeris received the award, and it has only been given for three years.nbsp; As the industrys most reliable and effective partner for developing population health management solutions, our success is driving tremendous growth in our company. Join us today in making a real difference in how healthcare is delivered! Why Join Lumeris? At Lumeris, you will be part of team that is focused on solving the nations healthcare problem, and you will be able to contribute to our purpose. Our environment is fast-paced, change-oriented and focused on growth and employee engagement. At Lumeris, we know that talent is best utilized when given the opportunity to succeed. That is why we have removed the boundaries that inhibit success and focus on fostering an environment that allows employees to utilize their talents.

  • Industry
    Financial Services