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Quality HEDIS/STARs Coordinator
2 months ago
We are seeking a highly skilled Quality HEDIS/STARs Coordinator - LVN/LPN to join our team at Optum. This role will be responsible for coordinating HEDIS and STARs data, educating patients on quality measures, and closing gaps in care.
Key Responsibilities- Analyze data to identify potential data integrity issues and document findings
- Analyze and trend HEDIS/STAR rates, identify barriers to improvement, and create interpretive exhibits
- Identify patients with missing measures and work to close gaps through education, counseling, and appointment setting
- Conduct outbound calls to members to discuss non-compliance with medication, schedule pharmacy appointments, and obtain follow-up information from providers
- Answer inbound calls from members and assist with inquiries, routing calls to the appropriate department as needed
- Document provider or member records with accurate information obtained on calls
- Work closely with local leadership to execute quality strategies and support PCPs/clinics with quality data collection
- Provide reports and monitor performance at the local level
- Engage PCP and clinic staff in developing strategies to close quality gaps and maintain education/knowledge base of HEDIS/STARs standards and guidelines
- Licensed Vocational/Professional Nurse
- 3+ years of healthcare experience, including experience in a managed care setting
- 3+ years of experience with data analysis/quality chart reviews, with the ability to review data and provide recommendations for improvement
- HEDIS/STAR experience or participation with similar regulatory reporting
- Experience using Microsoft office applications, including databases, word-processing, and excel spreadsheets
- 2+ years of college, in pursuit of a Bachelor's or Associate's degree
- 2+ years of experience working with HEDIS/STAR measures
