[Hiring] Licensed Practical Nurse - QA Nurse Specialist @Geisinger

Role Description

We strive to be the best in all we do. As a nationally recognized leader in healthcare, we continuously work to deliver excellent care and to excel across our organization. With a commitment to quality, safety and excellence, we’re guided by our priorities to ensure a leading standard of care. Join a team dedicated to quality healthcare here at Geisinger.

• Make an impact on quality care!
• Connect with members and providers, support HEDIS and prenatal/postpartum measures, and contribute to initiatives that improve care and outcomes.
• At least three (3) years of LPN work experience is required.
• Familiarity with medical record review and regulatory agency standards and computer literacy.
• A typical schedule is Monday - Friday, 8am - 4:30pm.
• Travel to assigned provider offices and to assigned community outreach events may be required.

Qualifications

• Graduate from Specialty Training Program-Nursing (Required)
• Minimum of 5 years-Nursing (Required)
• Licensed Practical Nurse - Default Issuing Body

Requirements

• Responsible for managing annual and proactive HEDIS (PAH) for compliant/non-compliant population.
• Responsible for and evaluated against success with outreach to assigned HEDIS/PNPP member case load.
• Responsible for retrospective medical record review to obtain clinical quality data per the HEDIS/PNPP specifications set forth by the National Committee for Quality Assurance (NCQA).
• Collaborates with Health Plan members and primary care providers in multiple practice sites to facilitate clinical guideline adherence and coordinates services as needed.
• Contributes to the design and implementation of interventions developed by quality improvement workgroups.
• Demonstrates understanding of regulatory agency standards by participating in annual educational sessions.
• Manages assigned member caseload to execute appropriate interventions to drive population outcomes.
• Responsible for conducting medical record reviews including physician progress notes, laboratory data, radiology and imaging reports, consult notes, etc.
• Demonstrates timely and accurate documenting of collected medical record data in the Quality database.
• Independently reviews targeted measures and collaborates with practitioners or members to ensure follow-up care is provided.
• Tracks member compliance reports and executes appropriate interventions for non-compliant members.
• Educates and collaborates with primary care physicians and site personnel regarding specific quality standards.
• Works with assigned provider office staff to educate members regarding the importance of preventive health guidelines.
• Works collaboratively with Health Choices population as an educator and clinical resource.
• Participates as a voting member within the member appeals process as appropriate and needed.
• Identifies opportunities for modifications in processes and assists Management with implementation.
• Responsible for reporting quality or potential fraudulent issues identified through daily activities.
• Responsible for referring members for Health and Case Management when appropriate.
• Work is typically performed in a clinical environment.

Benefits

• Full benefits (health, dental and vision) starting on day one.
• Three medical plan choices, including an expanded network for out-of-area employees and dependents.
• Pre-tax savings plans with healthcare and dependent care flexible spending accounts (FSA) and a health savings account (HSA).
• Company-paid life insurance, short-term disability, and long-term disability coverage.
• 401(k) plan that includes automatic Geisinger contributions.
• Generous paid time off (PTO) plan that allows you to accrue time quickly.
• Up to $5,000 in tuition reimbursement per calendar year.
• MyHealth Rewards wellness program to improve your health while earning a financial incentive.
• Family-friendly support including adoption and fertility assistance, parental leave pay, military leave pay and a free Care.com membership with discounted backup care for your loved ones.
• Employee Assistance Program (EAP): Referrals for childcare, eldercare, & pet care.
• Access free legal guidance, mental health visits, work-life support, digital self-help tools and more.
• Voluntary benefits including accident, critical illness, hospital indemnity insurance, identity theft protection, universal life and pet and legal insurance.