LVN/LPN Quality HEDIS/STARs Coordinator San Antonio Texas
: Job Details :

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

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 I-10 West, near West Frontage Road just past The Rim Shopping Center/Ferrari Dealership, 78257

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Licensed Vocational/Professional Nurse
• 3+ years of healthcare experience to include experience in a managed care setting
• 3+ years of experience with data analysis/quality chart reviews. Must be able to review data and provide recommendations for improvement
• HEDIS/STAR experience or participation with similar regulatory reporting
• Experienced using Microsoft office applications, including databases, word-processing, and excel spreadsheets

Preferred Qualifications:

• 2+ years of college, in pursuance of a Bachelor's or Associate's degree
• 2+ years of experience working with HEDIS/STAR measures

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.