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Nurse - Hedis Quality Improvement (LPN or RN) - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Federal Way, WA Federal Way, Washington |
About this job
Summary
The HEDIS QualityImprovement Nurse will support the various clinical quality improvement projectsand HEDIS related activities for STAR Ratings improvement as directed. He/she will focus on outreach initiativesto achieve quality improvement through member and provider engagement effortsas well as medical record retrieval and abstraction for annual HEDIS submission.This position assists in providing memberempowerment through the use of motivational interviewing skills, problemsolving and self-management goal setting. This position will also work withclinic staff and primary care physicians and assist members and providers to close HEDIS Care gaps. Acts as liaison between members andtheir providers to assist in closing gaps in care.
Essential Duties and Responsibilities
1. Support pro-active and retrospective HEDIS by being asubject matter expert in HEDIS clinical measures to include retrieval,abstraction, and quality over reads.
2. Identifiespopulation based member barriers to care and works with the team to identifystrategies to overcome barriers and close clinical gaps in care.
3. Participates in meetings with various departments to educate teamson care gaps, activities, issues or concerns.
4. Basedon medical record findings, provides follow-up education and practitioner interventionas needed to drive quality improvement. Works with providers on standards ofcare, and advises providers on established clinical practice guidelines
5. Maintains current knowledgeregarding chronic conditions such as Diabetes, Hypertension, CHF, CAD and COPD/Asthmaas well as treatments and medications related to each.
6. Performs member outreach calls aimedat linking members to preventive care services and medication adherence. Helps educatemembers about their medical condition and provide tips on coping.
7. Support members to stay on trackwith their treatment plans and offer emotional support. Establishes a trustingrelationship with identified members.
8. Perform member reminder calls andfacilitating member mailings, if necessary.
9. Supportscontinuum of member care by identifying members in need of health education andservices such as case management
10. Maintain compliance in all activitiesperformed.
11. Provides courteous and prompt serviceto all internal and external customers. Prioritizes and addresses requests andassignments in a professional manner to develop cooperative relationships
12. Performs otherduties as assigned.
Education and Experience
* Bachelor's degree preferred
* Current LPN or RN license required; 3 years of experienceworking with patients preferred
* HEDIS Quality Improvement experience
* Experience talking with members and providers over the phone
* Experience in disease management.
* 3 years' experience working in a Clinic, Hospital or ManagedCare environment
* Demonstratedcompetence with computer skills.
* Knowledgeof Microsoft Office, including Word, Excel, and PowerPoint.
* Ability to function effectivelywithin an ever-changing environment and to meet deadlines and reprioritize asnecessary.
* Ability to work both independentlyand within a team environment and a multi-dimensional environment
* Creative, flexible, self-motivated,professional must possess sound judgment ability to plan and initiate new activitiesconsistent with achieving service excellence.
* Excellent problem solving ability throughsystematic analysis and sound judgment.
* Ability to collaborate and influence othersunder positive or negative circumstances.
* Keen attention to detail with ability torelate with larger goals and listen critically.
* Problem-solving orientation to identify rootcause, develops solutions, and implement in close collaboration withthose doing the work.
Certificates, Licenses and Registrations
LPN or RN required
The HEDIS QualityImprovement Nurse will support the various clinical quality improvement projectsand HEDIS related activities for STAR Ratings improvement as directed. He/she will focus on outreach initiativesto achieve quality improvement through member and provider engagement effortsas well as medical record retrieval and abstraction for annual HEDIS submission.This position assists in providing memberempowerment through the use of motivational interviewing skills, problemsolving and self-management goal setting. This position will also work withclinic staff and primary care physicians and assist members and providers to close HEDIS Care gaps. Acts as liaison between members andtheir providers to assist in closing gaps in care.
Essential Duties and Responsibilities
1. Support pro-active and retrospective HEDIS by being asubject matter expert in HEDIS clinical measures to include retrieval,abstraction, and quality over reads.
2. Identifiespopulation based member barriers to care and works with the team to identifystrategies to overcome barriers and close clinical gaps in care.
3. Participates in meetings with various departments to educate teamson care gaps, activities, issues or concerns.
4. Basedon medical record findings, provides follow-up education and practitioner interventionas needed to drive quality improvement. Works with providers on standards ofcare, and advises providers on established clinical practice guidelines
5. Maintains current knowledgeregarding chronic conditions such as Diabetes, Hypertension, CHF, CAD and COPD/Asthmaas well as treatments and medications related to each.
6. Performs member outreach calls aimedat linking members to preventive care services and medication adherence. Helps educatemembers about their medical condition and provide tips on coping.
7. Support members to stay on trackwith their treatment plans and offer emotional support. Establishes a trustingrelationship with identified members.
8. Perform member reminder calls andfacilitating member mailings, if necessary.
9. Supportscontinuum of member care by identifying members in need of health education andservices such as case management
10. Maintain compliance in all activitiesperformed.
11. Provides courteous and prompt serviceto all internal and external customers. Prioritizes and addresses requests andassignments in a professional manner to develop cooperative relationships
12. Performs otherduties as assigned.
Education and Experience
* Bachelor's degree preferred
* Current LPN or RN license required; 3 years of experienceworking with patients preferred
* HEDIS Quality Improvement experience
* Experience talking with members and providers over the phone
* Experience in disease management.
* 3 years' experience working in a Clinic, Hospital or ManagedCare environment
* Demonstratedcompetence with computer skills.
* Knowledgeof Microsoft Office, including Word, Excel, and PowerPoint.
* Ability to function effectivelywithin an ever-changing environment and to meet deadlines and reprioritize asnecessary.
* Ability to work both independentlyand within a team environment and a multi-dimensional environment
* Creative, flexible, self-motivated,professional must possess sound judgment ability to plan and initiate new activitiesconsistent with achieving service excellence.
* Excellent problem solving ability throughsystematic analysis and sound judgment.
* Ability to collaborate and influence othersunder positive or negative circumstances.
* Keen attention to detail with ability torelate with larger goals and listen critically.
* Problem-solving orientation to identify rootcause, develops solutions, and implement in close collaboration withthose doing the work.
Certificates, Licenses and Registrations
LPN or RN required
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