Pride Healthcare is assisting a top healthcare organizationto identify the right person to fill a HEDIS - Clinical Quality LPN opening.
Responsibilities:
- Assisting in the review of medical records to highlight Star/HEDIS opportunities for the medical staff.
- Review medical records for data collection, data entry, and quality monitoring that close gaps in care.
- Partner with the leadership team, the practice administrative or clinical staff to identify trends observed and potential strategies to support the practice.
- Communicate challenges or trends that may negatively impact quality outcomes.
- Track and trend barriers/challenges that exist at their assigned groups so that better outcomes can be achieved including access to appointments lack of follow up on referrals, or inconsistent coding practices.
- Navigate multiple documentation systems and obtain medical record sections supportive of HEDIS/Star measures.
- Support quality initiatives by requesting medical records from provider’s offices as needed.
- Receives and responds to incoming Clinical Quality inquiries from all communication venues: e.g. phone and fax queue, TruCare, or department e-mail box.
- Conducts in-bound and out-bound calls for quality requirements including, but not limited to: medical records requests, contact verification.
- Provides clerical and/or administrative support to quality staff and managers for special projects and reporting needs.
- Provides excellent customer service by serving as a resource to all internal and external customers.
- Maintains education/knowledge base of HEDIS/STARs.
- Datamining
Requirements:
- Licensed Practical Nurse
- Minimum 2 year HEDIS experience and/or knowledge
- Solid knowledge of managed care requirements related to clinical quality
- Strong medical record review and abstraction prefer
- Research and detail oriented, excellent proof reading skills
- Excellent time management and prioritization skills
- Strong communication skills
- Strong proficiency with Microsoft Office applications, including: Word, Excel, Adobe and PowerPoint
- Critical thinking skills
- • Results-driven independent worker, and self-starter
Additional Details:
- Client prefers onsite candidates in the San Antonio area, but is willing to interview fully remote candidates in other areas.
- This is for the Quality SDS/PSV Operations Department.
- 1-2 week training, limited time off, will be discussed during interview.
- Mon-Fri- 8-5 CST, after hours and Weekend work may be required
- HEDIS and Chart chase experience required
Must be authorized to work in the United States. Pride Health offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), a 401(k)-retirement savings, life & disability insurance, an employee assistance program, identity theft protection, legal support, auto and home insurance, pet insurance, and employee discounts with some preferred vendors.
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Pride Health is Pride Global's healthcare staffing branch, providing recruitment solutions for healthcare professionals and the industry at large since 2010. As a minority-owned business that delivers exceptional service to its clients and candidates by capitalizing on diverse recruiting, account management, and staffing backgrounds, Pride Health's expert team provides tailored and swift sourcing solutions to help connect healthcare talent with their dream jobs. Our personalized approach within the industry shines through as we continue cultivating honest and open relationships with our network of healthcare professionals, creating an unparalleled environment of trust and loyalty.
