Clinical Quality LVN

Job Title : Clinical Quality LPN

Location : San Antonio, TX, 78257

Duration : 3 months contract to hire

Shift : Mon-Fri- 8-5 CST, after hours

Hours per Week : 40 hours per week

Rate : $30.00 per hour

Team of 30- (24 LVN / LPN) (3 CTAs) (2 Sups) (1 BA) (1 director)

Responsibilities

1. Identifies patients with the missing measures and works to close the measures through education / counseling, appointment setting, and other means as appropriate.

2. 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.

3. May answer inbound calls from members and assists them with their inquiries. Routes calls to appropriate department if necessary.

4. Follows system scripting and validates member demographic information.

5. Documents the provider or member's record with accurate information obtained on the call.

6. Works closely with local leadership to execute quality strategies.

7. Supports and assists PCPs / clinics with quality data collection.

8. Provides reports and monitors performance at local level.

9. Engages PCP and clinic staff in developing strategies to close quality gaps.

10. Maintains education / knowledge base of HEDIS / STARs standards and guidelines.

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.

Current Unrestricted LVN license in state of Texas