Clinical LPN HEDIS- 116027

Job Summary

This position is responsible for the coordination of HEDIS and STARs data. This role is responsible for education to the patient on quality measures and coordinates strategies for closing gaps. The Quality Coordinator LVN, through telephonic outreaches will educate patients on CAHPS & HOS components while working to close other HEDIS gaps for patients. Evaluates the quality and completeness of clinical gap closures by performing quality reviews with patients, maintaining clinical documentation, and accurately records of their review activities. The Quality Coordinator LVN will maintain up-to-date knowledge of regulatory (HEDIS/STARs) standards and guidelines.

Essential Job Functions
1. Analyze data, evaluate for possible data integrity and data deficits and document findings.
2. Analyze and trend HEDIS/STAR rates, identify barriers to improvement of rates and create interpretive exhibits.
3. Identifies patients with the missing measures and works to close the measures through education/counseling, appointment setting, and other means as appropriate.
4. Conduct a high volume of outbound calls to members to discuss reasons for non-compliant to medication(s), schedule pharmacy telephonic appointments, and/or obtain important follow up information from providers. Outbound calls are made primarily using an auto dialer requiring precision to detail and adaptability to type of response needed.
5. May answer inbound calls from members and assists them with their inquiries. Routes calls to appropriate department if necessary.
6. Follows system scripting and validates member demographic information.
7. Documents the provider or member's record with accurate information obtained on the call.
8. Works closely with local leadership to execute quality strategies.
9. Supports and assists PCPs/clinics with quality data collection.
10. Provides reports and monitors performance at local level.
11. Engages PCP and clinic staff in developing strategies to close quality gaps.
12. Maintains education/knowledge base of HEDIS/STARs standards and guidelines.
13. Performs all other related duties as assigned.

Minimum Required Education, Experience & Skills
? Licensed Vocational/Professional Nurse
? Prior HEDIS/STAR experience or participation with similar regulatory reporting.
? Three or more years of healthcare experience to include experience in a managed care setting.
? Three or more years of experience with data analysis/quality chart reviews. Must be able to review data and provide recommendations for improvement.
? Experienced using Microsoft office applications, including databases, word-processing, and excel spreadsheets.

Preferred Education, Experience & Skills
? Two or more years of college, in pursuance of a Bachelor’s or Associate’s degree.
? Two or more years of experience working with HEDIS/STAR measures.

Physical & Mental Requirements: (check all that apply)
Ability to lift up to 25 pounds
Ability to push or pull heavy objects using up to pounds of force
Ability to sit for extended periods of time
Ability to stand for extended periods of time
Ability to use fine motor skills to operate office equipment and/or machinery
Ability to properly drive and operate a company vehicle
Ability to receive and comprehend instructions verbally and/or in writing
Ability to use logical reasoning for simple and complex problem solving