Job Description

Position background:
What are the top 5-10 responsibilities for this position?
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.
11. Performs all other related duties as assigned.
What does the ideal candidate background look like?
Someone detail oriented familiar with multiple computer programs at once who can document while on call with member or provider

What skills/attributes are required (please be detailed as to number of years of experience for each skill)?
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.

Does this position require a professional license or certification? If so please list. Current Unrestricted LVN license in state of Texas
What is the dress code (ex: business casual scrubs etc.)? business casual
How would you prefer to interview? (Video phone or in person? How many rounds?) video or in person- 1 round

Job Tags

Casual work, Work at office, Local area,

Similar Jobs