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

Skills

  1. Proficient in Microsoft Office, with emphasis on Word and Excel
  2. Customer service oriented
  3. Ability to multi-task
  4. Talking to others to convey information effectively.
  5. Active problem solver.
  6. Logical thinking.
  7. Knowledge of medical terminology.
  8. Understanding of Medical Home standards.
  9. Team player.
  10. Exceptional organizational skills.
  11. Knowledge of Medical Health Record (EHR).
Ability
  1. Ability to understand data, review medical records and clinical quality procedures according to established protocols.
  2. Ability to maintain quality, safety, and/or infection control standards.
  3. Ability to run and analyze quality reports when needed.
  4. Ability to track, monitor and validate data.
Tasks and Responsibilities

Core duties and responsibilities include the following:
  1. Coordinating and completing HEDIS quality specific projects ensuring consistency with BHCC strategy, commitments, and goals
  2. Maintain active, validated health plan specific rosters
  3. Identify, call, and schedule patients to address gaps in care. This includes adults, pediatrics, specialty care, and People Living with HIV/AIDS
  4. Track quality measures and provide training to clinical staff as needed to improve performance
  5. Assist with Chronic Care management (CCM) Share Medical Appointments
  6. Track hospitalization and ER/UC discharges and recall patients for continuity of care
  7. Proactively seek resources to identify gaps on existing or quality projects as they arise
  8. Performs other analyses to assist with documentation
  9. Periodically audit records to confirm compliance with UDS, HEDIS, and NCQA standards
  10. Ensures proper follow-through with clinical teams for patients who are engaged for care gap closure to minimize lost opportunities.
  11. Verify and update patient registration information, including insurance, demographic and patient data when scheduling appointments
  12. The ability to retrieve, communicate, present data and information both verbally and written
  13. Provides paneling information provided to Health Plans is accurate and timely
  14. Coordinates with Quality Manager on a weekly basis
  15. Chart Audit: Internal and External Chart Audits when requested
  16. Perform and track call campaigns for non- compliant patients to increase access to care
  17. Increase and track access to care for patients that have not attended in the last six months their primary care provider visit
  18. Deliver cross-organizational trainings and audits related to areas of quality improvement; examples include correct blood pressure measurement and A1c screening.
  19. Participate in special care events as a member of the clinical team.
III. ADDITIONAL RESPONSIBILITIES
  1. Follows Borinquen Health Care Center's as well as governmental policies and procedures.
  2. Supports QI-QA Plan and PLWHA Clinical Guidelines.
  3. Supports clinical activities as needed
  4. PDSA maintenance and support
  5. QI project follow up and trend analysis
IV. JOB RELATIONSHIPS
  1. Responsible: Quality Manager.
  2. 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 REQUIREMENTS
  1. Active nursing license in the State of Florida. RN Preferred
  2. Well organized and Bilingual (Spanish and/or Creole).
  3. Computer literacy with proficiency and expertise in Microsoft Office, including Outlook, Word, and Excel.
  4. Ability to interact effectively with patients, administration, faculty, and staff.
  5. Handle information with high level of confidentiality.
  6. Considerable knowledge of standard concepts, practices, and procedures within a field.
  7. Relies on limited experience and judgment to make decision, plan and accomplish goals.
  8. Minimum 1 year of direct patient care in an outpatient setting.
Desired REQUIREMENTS
  1. Bachelor's Degree.
  2. Experience with case management, Ryan White/People Living With HIV/AIDS


BENEFITS
  • Medical/Dental/Vision/Short Term Disability
  • Company paid long term disability
  • Life insurance
  • 401K Plan
  • Standard Paid Holiday's
  • Vacation and Sick Time
  • Amazing Team & Atmosphere

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