HEDIS Nurse Specialist

Found in: Lensa US P 2 C2 - 2 weeks ago

Miami, United States Borinquen Health Care Center Full time

Borinquen Medical Centers is located in Miami, FL and is seeking to hire a full time HEDIS Nurse Specialist. The HEDIS Nurse Specialist will be a member of the Quality Department working in collaboration with the different clinical departments to close care gaps. The position will utilize information collected from the EHR, health plan portals, and direct communication from health plans to identify, contact, and schedule visits with patients. This position is also responsible for communicating directly with providers when care management, referrals, and other patient needs arise that inhibit the closure of care gaps. As a key member of the Quality Department, this position must be comfortable with leading training and support meetings with clinical and provider staff groups that lead to better gap closure rates from the department. Knowledge of and compliance with appropriate documentation and coding is a critical component of this positions success. Additional roles for this position includes tracking patients recently discharged from the ER/UC, hospital, and other outpatient facilities; facilitating QI projects and exercises, such as PDSA and process mapping; and assisting as a clinical staff member during special care events II. SKILLS, KNOWLEDGE, ABILITIES, TASKS AND RESPONSIBILITIES SkillsProficient in Microsoft Office, with emphasis on Word and Excel Customer service orientedAbility to multi-taskTalking to others to convey information effectively.Active problem solver.Logical thinking.Knowledge of medical terminology.Understanding of Medical Home standards.Team player.Exceptional organizational skills.Knowledge of Medical Health Record (EHR).AbilityAbility to understand data, review medical records and clinical quality procedures according to established protocols.Ability to maintain quality, safety, and/or infection control standards.Ability to run and analyze quality reports when needed.Ability to track, monitor and validate data.Tasks and ResponsibilitiesCore duties and responsibilities include the following:Coordinating and completing HEDIS quality specific projects ensuring consistency with BHCC strategy, commitments, and goalsMaintain active, validated health plan specific rosters Identify, call, and schedule patients to address gaps in care. This includes adults, pediatrics, specialty care, and People Living with HIV/AIDSTrack quality measures and provide training to clinical staff as needed to improve performanceAssist with Chronic Care management (CCM) Share Medical AppointmentsTrack hospitalization and ER/UC discharges and recall patients for continuity of careProactively seek resources to identify gaps on existing or quality projects as they arisePerforms other analyses to assist with documentationPeriodically audit records to confirm compliance with UDS, HEDIS, and NCQA standardsEnsures proper follow-through with clinical teams for patients who are engaged for care gap closure to minimize lost opportunities. Verify and update patient registration information, including insurance, demographic and patient data when scheduling appointmentsThe ability to retrieve, communicate, present data and information both verbally and writtenProvides paneling information provided to Health Plans is accurate and timelyCoordinates with Quality Manager on a weekly basisChart Audit: Internal and External Chart Audits when requestedPerform and track call campaigns for non- compliant patients to increase access to careIncrease and track access to care for patients that have not attended in the last six months their primary care provider visit Deliver cross-organizational trainings and audits related to areas of quality improvement; examples include correct blood pressure measurement and A1c screening. Participate in special care events as a member of the clinical team. III. ADDITIONAL RESPONSIBILITIESFollows Borinquen Health Care Center's as well as governmental policies and procedures.Supports QI-QA Plan and PLWHA Clinical Guidelines.Supports clinical activities as neededPDSA maintenance and supportQI project follow up and trend analysisIV. JOB RELATIONSHIPSResponsible: Quality Manager.Interrelationships: Patient Care Team (Primary Care Physician, Clinical Managers, Nutritionists, Mental Health Specialist, Podiatrist, Chief Quality Officer, Chief Medical Officer and Director of Clinical Services, Ancillary Services and MCM) and Other Care Specialists.V. MINIMUM REQUIREMENTSActive nursing license in the State of Florida. RN PreferredWell organized and Bilingual (Spanish and/or Creole).Computer literacy with proficiency and expertise in Microsoft Office, including Outlook, Word, and Excel. Ability to interact effectively with patients, administration, faculty, and staff.Handle information with high level of confidentiality.Considerable knowledge of standard concepts, practices, and procedures within a field.Relies on limited experience and judgment to make decision, plan and accomplish goals.Minimum 1 year of direct patient care in an outpatient setting.Desired REQUIREMENTSBachelor's Degree.Experience with case management, Ryan White/People Living With HIV/AIDSBENEFITSMedical/Dental/Vision/Short Term DisabilityCompany paid long term disabilityLife insurance401K PlanStandard Paid Holiday'sVacation and Sick TimeAmazing Team & Atmosphere

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