About us:
Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.
Brief summary of purpose:
Under the general direction of the Senior Manager, Clinical Quality, the clinical nurse analyst is responsible for developing and implementing the assigned quality improvement initiatives, documentation of the processes, tracking of results and reporting outcomes. Other key responsibilities include medical record data abstraction for Healthcare Effectiveness Data and Information Set (HEDIS®) and MassHealth Appendix Q review. The clinical nurse analyst will provide clinical expertise and support for departmental initiatives and the Quality Program structure as well as periodically assist in file review for NCQA accreditation.
Primary Job Responsibilities:
Education:
Bachelor’s Degree in nursing preferred.
License/Certifications
Experience
Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
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