Quality Specialist LPN
About The Position
Valley Medical Group is looking for a Quality Specialist Licensed Practical Nurse to join their Family Practice team and work in their Greenfield Health Center. This role is in a dynamic environment and offers no nights or holidays. The Quality Specialist LPN will be assigned projects and roles that contribute to the quality program, provide chart audit for risk adjustment projects, provide review and data entry into EMR for the accurate documentation of quality measures and preventative services, review and maintain filing and follow up for patient experience, complaint and incident reporting program as well as targeted projects to provide guidance to providers for appropriate diagnostic coding for risk adjustment that represents each patient’s level of chronic illness.
Requirements
- Current Massachusetts LPN License (or able to obtain licensure in MA)
- Graduate of an accredited school of nursing (Associates or Bachelors)
- Knowledge of chronic diseases, medications, disease management guidelines, medical terminology, ICD-10 coding, and knowledge of Hierarchal Condition Categories.
- Minimum of 2 years outpatient medical experience
- Current CPR certification
- Strong organizational skills that reflect ability to perform and prioritize multiple tasks seamlessly with excellent accuracy and attention to detail
Nice To Haves
- Athena experience a plus
Responsibilities
- HCC coding and risk adjustment review and analysis: review patients for targeted diagnosis gaps and update the EMR to reflect appropriate HCC diagnosis, and perform chart prep for the upcoming appointment.
- Review/abstract information from transferred medical records to update EMR quality measures and preventative services for new patient charts.
- Coordinate transition of care follow up phone calls with case management programs. Perform follow up phone calls, TCMS documentation for all appropriate patients not managed by risk contract case management staff. Update medication lists and problem lists as appropriate, schedule TCMS or Hospital/ER/SNF follow up appointments with PCP.
- Liaison with health plan quality and HCC programs, updating HCC and preventative services in the health plan software platform to meet metrics for performance.
- Review and file Incident and complaint forms. Follow up with appropriate managers and supervisors for outstanding or incomplete forms.
- Review and manage patient experience data, initiate the patient complaint and incident review process for any comments provided less than 70% willingness to recommend, or comments that constitute a patient complaint regarding customer service or care.
- Perform chart audit and data abstraction as needed for health plan risk contracts.
- Collaborate with other departments and key personnel including the Quality Physician, Quality Director, Health Information Coordinator, case management staff and clinical supervisors.
- Quality LPNs perform special projects as needed that include research and review of EMR data.
Benefits
- Medical, Dental & Vision Plans
- 401(k) Plan with Company Match
- Health Savings Account & Flexible Spending Account
- Generous Paid Time Off
- 7 Paid Holidays
- Company-Paid Long-Term Disability Insurance
- Company-Paid Life Insurance
- Voluntary Life, Accident and Critical Illness Insurance Options
- Company Wellness Program
- Employee Assistance Program
- Free On-Site Parking
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
