Job Description

Opportunities at WellMed,   part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind   Caring. Connecting. Growing together.

 $1K Sign on Bonus for External Candidates

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.

  Primary Responsibilities: 

• Analyze data, evaluate for possible data integrity and data deficits and document findings
• Analyze and trend HEDIS/STAR rates, identify barriers to improvement of rates and create interpretive exhibits
• Identifies patients with the missing measures and works to close the measures through education/counseling, appointment setting, and other means as appropriate
• 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
• May answer inbound calls from members and assists them with their inquiries. Routes calls to appropriate department if necessary
• Follows system scripting and validates member demographic information
• Documents the provider or member's record with accurate information obtained on the call
• Works closely with local leadership to execute quality strategies
• Supports and assists PCPs/clinics with quality data collection
• Provides reports and monitors performance at local level
• Engages PCP and clinic staff in developing strategies to close quality gaps
• Maintains education/knowledge base of HEDIS/STARs standards and guidelines
• Performs all other related duties as assigned

  This is an office-based position located near Interstate Highway]]> <

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