Hybrid-MI Licensed RN Quality&ProviderEducation/HEDISmeasures/orcoding

Energy Jobline; Grand Rapids (MI); Hybrid; USD 57,000 - 100,000; Full time

Job summary

A leading healthcare provider is looking for a Hybrid-MI Licensed RN specializing in Quality and Provider Education. This role involves executing essential tasks that include educating providers on HEDIS measures, conducting clinical reviews, and maintaining effective relationships with providers across Michigan. The position offers a combination of remote work and onsite visits, requiring travel throughout the state. Candidates must have a valid MI RN license and experience in clinical settings.

Qualifications

• Current unrestricted RN license in Michigan required.
• Minimum three years of clinical experience.
• Strong knowledge of NCQA HEDIS measures.

Responsibilities

• Conduct educational sessions with providers on relevant topics.
• Perform clinical reviews and maintain relationships with providers.
• Assist in monitoring issues related to corporate initiatives.

Skills

Knowledge of quality improvement

Clinical guidelines

Effective communication skills

Analytical skills

Problem-solving skills

Education

Bachelor's degree in nursing

RN licensed in Michigan

Tools

MS Office Suite

Excel

SharePoint

Job description

Hybrid-MI Licensed RN Quality&ProviderEducation/HEDISmeasures/orcoding

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Hybrid-MI Licensed RN Quality&ProviderEducation/HEDISmeasures/orcoding

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Job DescriptionJob Description

MI Licensed RN Quality and Provider Education/HEDIS measures or coding exp

Job DescriptionJob Description

MI Licensed RN Quality and Provider Education/HEDIS measures or coding exp

2894R-1 long term 37.00 AN HOUR W2 contract + 5 PTO days

End Date: 10/31/2025

Position Type: Full Time/Contract

Location: Grand Rapids, MI, United States

Onsite Flexibility: 50% Remote

Location: Offsite / remote worker the majority of the time. Will need to be able to go into the Grand Rapids Steketee's building on occasion (need varies throughout year). Will need badge on start date.

Expense Reimbursement: Total miles - normal commuter miles = reimbursement

While the position mostly includes remote work and traveling, the resource will be required to work onsite at a client location occasionally. This project will involve participating in provider visits to develop partnerships, provide training, education, and review of medical records as well as other requests that support a variety of corporate initiatives. Knowledge of NCQA HEDIS measures is but will interview qualified RNs. The candidate must be licensed as a Registered Nurse in the state of Michigan and have a dependable vehicle. In-state travel requirements vary throughout the year and could be up to five days a week at times.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following (other duties may be assigned):

• 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 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. 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
  
  

Qualifications

To perform this job successfully, an individual must be able to effectively execute each essential duty. Contractors will be expected to attend annual training on HEDIS measures at the beginning of each year, and must pass according to predetermined testing requirements. The requirements listed below are representative of the knowledge, skill, and/or ability required throughout the year, although others may be needed.

Top 3 Required Skills / Experience

Current unrestricted state of Michigan registered nurse license required

Knowledge of quality improvement / process improvement / clinical guidelines

Experience with MS Office skills. Excel and SharePoint are a plus.

Required Skills / Experience

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

RN with HEDIS experience but will interview qualified RNs. RNs with professional coding experience is a plus.

Have a dependable vehicle every workday and be willing to travel up to five days a week and stay overnight when appropriate

Skills / Experience

Minimum three years of clinical experience

Bachelor's degree in nursing

Strong knowledge and experience in use of software (e.g., Excel, Outlook, PowerPoint, Word, etc.).

Knowledge of NCQA HEDIS measures

Medical chart review experience

Effective communication skills, written and verbal

Five years of 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.

Education / Certifications

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

Company DescriptionFounded in 1998 and headquartered in Farmington Hills, MI, Kyyba has a global presence delivering high-quality resources and top-notch recruiting services, enabling businesses to effectively respond to organizational changes and technological advances.

At Kyyba, the overall well-being of our employees and their families is important to us. We are proud of our work culture which embodies our core values; incorporating value, passion, excellence, empowerment, and happiness, creates a vibrant and productive atmosphere. We empower our employees with the resources, incentives, and flexibility that they need to support a healthy, balanced, and fulfilling career by providing many valuable benefits and a balanced compensation structure combined with career development.

Kyyba is an Equal Opportunity Employer.

Kyyba does not discriminate on the basis of , , , sex, , , , non-disqualifying physical or mental , , veteran status or any other bCompany DescriptionFounded in 1998 and headquartered in Farmington Hills, MI, Kyyba has a global presence delivering high-quality resources and top-notch recruiting services, enabling businesses to effectively respond to organizational changes and technological advances. At Kyyba, the overall well-being of our employees and their families is important to us. We are proud of our work culture which embodies our core values; incorporating value, passion, excellence, empowerment, and happiness, creates a vibrant and productive atmosphere. We empower our employees with the resources, incentives, and flexibility that they need to support a healthy, balanced, and fulfilling career by providing many valuable benefits and a balanced compensation structure combined with career development. Kyyba is an Equal Opportunity Employer. Kyyba does not discriminate on the basis of , , , sex, , , , non-disqualifying physical or mental , , veteran status or any other b

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Renewable Energy Power Generation, Engineering Services, and Oil, Gas, and Mining

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