Health Net, Inc. is a publicly traded managed care organization that delivers managed health care services through health plans and government-sponsored managed care plans. Its mission is to help people be healthy, secure and comfortable. Health Net, through its subsidiaries, provides and administers health benefits to approximately 5.4 million individuals across the country through group, individual, Medicare (including the Medicare prescription drug benefit commonly referred to as "Part D"), Medicaid, U.S. Department of Defense, including TRICARE, and Veterans Affairs programs. Health Net's behavioral health services subsidiary, Managed Health Network, Inc., provides behavioral health, substance abuse and employee assistance programs to approximately 4.9 million individuals, including Health Net's own health plan members. Health Net's subsidiaries also offer managed health care products related to prescription drugs, and offer managed health care product coordination for multi-region employers and administrative services for medical groups and self-funded benefits programs.
For more information on Health Net, Inc., please visit the company's website at
Analyze performance data to evaluate the efficiency and effectiveness of clinical processes. Perform quality audits of all clinical functions. Work with the clinical business units to develop and implement preventive and/or corrective action plans as needed.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Performs quality audits of clinical functions.
- Analyzes performance data to evaluate the efficiency and effectiveness of clinical processes.
- Works with clinical business units to develop and implement preventive and/or corrective action to remedy or prevent performance failures.
- Tracks quality improvement activities, assesses trends and provides reporting to various departments and committees.
- Reviews and assesses the documentation used in clinical business units to ensure compliance with the control of documentation requirement.
- Facilitates process improvement in clinical business units.
Bachelor's degree in a clinical field
Licensed RN; CPHQ certification required within 18 months of hire
Minimum three years managed care experience
Knowledge, Skills & Abilities:
As a government contractor, this position requires U. S. citizenship and proof of favorable adjudication following submission of Department of Defense form SF86 or higher security.
- Excellent interpersonal, verbal, and written skills
- Ability to work effectively in a team environment
- Skilled in use of Microsoft office applications
- Good analytical skills
- Effective auditing skills
- Excellent facilitation skills
Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.
The following section describes the general physical requirements for this position. Please note that 'constant' refers to more than 81% of time; 'significant' refers to 40-80%; and 'moderate' refers to 20-40% of the time.
Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening.
- Operates personal computers, printers, facsimile, telephones, copy machines and other commonly used office accessories/equipment.
- Exposed to confidential information and expected to maintain confidentiality at all times; must adhere to HIPAA rules and regulations.
- May be required to work outside of normally scheduled hours as mandated by the client, project and/or workload (e.g. evenings, weekends, and/or holidays).
- May be required to maintain established work pace, meet deadlines; may have last minute urgent requests.
- Physical activity may include: twisting, reaching, kneeling, bending, stooping, squatting, crawling, grasping, grabbing, pushing, pulling, repetitive motion, climbing, etc.
- Required to have visual acuity to determine the accuracy, neatness, and thoroughness of the work assigned.
- Required to have hearing ability to receive detailed information through oral communication.
- Required to have speaking ability to express or exchange ideas.
- Constant concentration may be required on various subjects by listening, reading and thinking clearly.
- Interaction with others may be required. May need to listen, think, and speak in order to interact with others. Business interactions and behavior between coworkers and/or external customers are required. This may require face-to-face or telephone interactions.
- Thinking at work may include listening, learning, analyzing, evaluating, and the ability to interpret what is seen and/or heard, or to link information from one issue to the next.
- Constant computer usage including typing and/or eye strain.
- Constant repetitive arm, wrist, hand and finger motions -- making repetitive movements (e.g. key boarding, filing, data entry).
- Constant phone usage; headsets may be required.
may be required between work sites and/or out of area.
- Moderate lifting may be required.
May need to lift, carry and/or move equipment/supplies weighing up to
pounds, always using safe lifting techniques.
- Moderate amount of time spent working in a loud office environment with frequent interruptions/distractions.
- Constant sedentary work (desk bound or seated).
- Constant reading is required via computer screen and/or bound printed materials.
- Moderate walking/standing may be required.
Walking and/or transporting supplies and equipment between buildings/parking lots and structures may be required.
Health Net and its subsidiaries are an Equal opportunity/Affirmative Action Employer M/F/V/D.
Health Net - 10 months ago