NEW JOB OPENING
CLINICAL QUALITY LPN
IN San Antonio, TX, USA!

Required Qualifications:

• 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



Preferred experience:

• Market specific data entry and collection

• Medical record review and abstraction for HEDIS and HEDIS-like measures

• Other duties as assigned

• Datamining



Essential Job Functions

• 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



Responsibilities:

• Reviews assigned medical records in order to verify clinical data elements for HEDIS reporting,

• Identifies findings supported by documentation guidelines with high level of accuracy

• Maintains HIPAA standards and confidentiality of protected health information; reports critical incidents immediately.

• Prioritize and organize own work to meet agreed upon deadlines.

• Communicates identification of pursuit leads for additional medical records, if needed, to other members of the team

• Attends conference calls as necessary to provide information relating to clinical reviews and compliance

• Successfully completes HEDIS technical specification training and testing

• Successfully completes HEDIS software training and uses software correctly

• Performs other duties as assigned

• **Only those lawfully authorized to work in the designated country associated with the position will be considered.**

• **Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements.**