PURPOSE OF POSITION:
The primary purpose of the RN Clinical Intervention Specialist is to lead condition-specific workgroups, collaborate with providers, members and peers to ensure engagement, and, to analyze gaps in care, barriers to care and opportunities for improvement. The Clinical Intervention Specialist will ensure regulatory requirements are met by leading cross-functional teams, conducting root cause analyses, and reviewing and interpreting HEDIS data.

RESPONSIBILITIES & EXPECTATIONS:
• Designs and implements member- and provider-specific interventions
• Ensures alignment of all interventions with the HEDIS Strategic Plan and the Quality Program/Plan.
• Assesses care opportunities for member and provider action.
• Tracks member and provider engagements responses and outcomes achieved, analyzing findings and making recommendations for improvements to quality of care.
• Creates and maintains positive relationships with internal and external customers.
• Assists with HEDIS Hybrid medical record review, supplemental data collection and NCQA-required chart audits.
• Process Improvement: Continuously reviews, recommends and implements improvement steps, as needed or directed.
• Seeks supervisory guidance/approval as appropriate.
• Portrays professional image: follows dress code; communicates with internal and external customers in a professional manner, including appropriate verbal and written grammar.
• Promotes and demonstrates professional standards to enhance the development of the department including:
o Performs all job functions in an independent manner (as needed or directed)
o Recognizes and performs job functions with little or no supervision
o Demonstrates strong organizational skills
o Responds positively to change in work flow as needed
o Offers assistance to co-workers (as needed)
o Maintains flexibility to meet department needs, including adjusting work hours
o Consistently completes assigned work in required time frame; completes other duties as required
o Collaborates and cooperates with co-workers, supervisors, etc., creating a productive working relationship throughout the organization
o Actively seeks and pursues opportunities to make a contribution and demonstrates desire for learning
• Practices Ethical Conduct:
o Demonstrates honesty and integrity in all functions and relationships
o Maintains AultCare standards of confidentiality, including HIPAA privacy guidelines
o Complies with policies and procedures at all times
• Meets acceptable attendance and punctuality expectations (excluding FMLA)
• Creates and reviews policies and procedures as needed

The above statements reflect the general duties considered necessary to describe the principle functions of the job as identified, and shall not be considered as a detailed description of all the work requirements that may be inherent to this position.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, age, national origin, disability, or veteran status. AultCare is an EEO/AA Employer M/F/Disability/Vet.

QUALIFICATIONS:
• Education: Bachelor's Degree in Nursing required.
• Experience: Minimum three years clinical experience. Prefer experience with managed care, disease management and member or provider engagement strategies. Proficiency in Microsoft Word, Excel, Access and Power Point. Must possess intermediate computer skills and be able to analyze and trend data.
• Licensure: Current, unrestricted RN license in State of Ohio.
• Knowledge and Skills: Strong written and verbal communication skills. Subject matter expert in condition states: preventive care, asthma, diabetes, cardiovascular disease, behavioral health and perinatal care. Understanding of Medicaid and Medicare preferred.

WORKING CONDITIONS:
• Hours of operation, shifts as assigned. Occasional overtime, on-call, off-shifts (evenings and/or weekends) scheduled as necessary.
• Lunch and break periods must be coordinated with other staff members to maintain adequate office staffing during departmental operating hours.
• Sitting/standing/moving about intermittently during working hours.
• Subject to frequent interruptions and changes in priority of duties throughout the day.