LVN Case Manager
About The Position
The LVN Case Manager will engage physicians and office staff to facilitate discussions on HEDIS Part C and Part D measures. This role involves performing medical record reviews, abstraction, and data entry for HEDIS to close GAPs in care. The position requires preparing reports and presentations, conducting monthly reviews, tracking compliance issues, and staying informed about HEDIS/STAR rating requirements. The LVN Case Manager will also prepare, submit, and bill findings to external stakeholders, ensuring adherence to reporting deadlines, and presenting summaries of tracking reports to identify areas of improvement. Road travel is required for approximately 25% of the time within the Victor Valley surrounding cities. Other related duties as assigned.
Requirements
- High School graduate
- Graduate from an accredited school for Vocational Nurses.
- Current California LVN license.
- One year experience with HEDIS/STAR, medical records review.
- Required computer applications Excel, Word, Outlook, Power Point.
- Able to work in a multi-task, high demand environment.
- Driver’s License and proof of Auto Insurance.
Responsibilities
- Engages physicians and office staff to facilitate discussions on HEDIS Part C and Part D measures.
- Performs medical record reviews, abstraction and data-entry for HEDIS as part of HEDIS operations to close GAPs in care.
- Prepares reports and presentations outlining progress findings, and recommendations for management or regulatory bodies.
- Conducts monthly reviews in a timely manner and in accordance with established guidelines.
- Tracks compliance issues, trend data, prepares regular reporting to enhance performance related to HEDIS measures, and distributes to providers and internal teams.
- Stays informed about the HEDIS/STAR rating requirements and applicable annual updates.
- Prepares, submits, and bill findings to external stakeholders, ensuring adherence to reporting deadlines.
- Presents a summary of all tracking reports to identify areas of improvement monthly or upon request.
- Performs other related duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
