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Quality Improvement Nurse (LPN or RN) [Hospice/Home Health experience preferred]

Employer
Vantage Health Plan, Inc.
Location
Laings, OH
Closing date
Sep 15, 2021

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Profession
Nurse
Specialty
Medical Management
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Job Details

A t Vantage Health Plan, we specialize in taking care of people: our members, our patients, and our employees. We offer competitive salaries and great benefits! Benefits include: Health, Dental, Life, Accidental Death and Dismemberment, Long Term Disability, Paid Time Off, and 401(k).

Vantage is currently looking for a Quality Improvement LPN or RN to work from 8:00AM - 5:00PM, Monday through Friday.


Job Summary:


The Quality Improvement Nurse (LPN or RN) will strive to improve the quality of care of members within Vantage Health Plan by actively participating in the development and measurement of quality improvement programs. The Quality Improvement Nurse is responsible for the coordination of Healthcare Effectiveness Data and Information Set (HEDIS) data gathering process by performing quality medical record reviews, assisting providers and staff in the improvement of the clinical documentation process, ensuring all data submitted to the health plan meets HEDIS technical specifications and performing in home nurse visits to close gaps in care that directly helps to improve the overall Star Rating of the health plan.

Essential Duties & Responsibilities:

  • Perform chart reviews in provider offices/facilities in January - May (HEDIS Season) to abstract data needed for quality reporting to CMS/NCQA (National Committee for Quality Assurance)

    • Perform chart audits in various provider offices and electronically to ensure that the correct CPT/diagnoses have been submitted

    • Retrieves and analyzes data within various systems (Vnet, Acuity, Q-NXT, and Centricity) on an ongoing basis regarding Vantage inpatient admissions and discharges

    • Telephonic follow up with physicians on compliant patient care (based on HEDIS measure)

    • Collaborate with various offices to ensure that preventative health care screenings are performed based on best practice guidelines (i.e. colorectal screenings, Hemoglobin A1-Cs, Diabetic eye exams, immunizations, mammograms)

    • Perform In-Home nurse visits June - December for diabetic testing and In-Home nurse visits throughout the year for osteoporosis testing

    • Review care plans for patients to ensure it complies with physician orders

    • Maintain confidentiality regarding patient and business functions of the organization

    • Promote favorable working conditions and relationships with administration, medical staff, consultants, other departments, patients, family members, volunteers, agencies, and any other individual or group affiliated with Vantage Health Plan

    • Collaborates with the PCP when need arises

    • Identify and prioritize primary problems within physician offices

    • Chart individual nurse home visits within electronic medical record (Centricity)

    • Works collaboratively with other departments and team members within Vantage Health Plan and Affinity Health Group

    • Documentation within Excel, Vnet, Q-NXT, and Centricity
  • Marginal Duties:


• Assist in training and continuing education of all providers and office staff to plan objectives, policies, and procedures

• Assist in continuously improving quality of care

• Assist in creating policies and procedures within the realm of quality of care

• Other duties as assigned

Job Requirements:

Knowledge, Skills, and Abilities:



Graduate of an accredited school of Registered Nursing with a current license to practice as a RN in the State of Louisiana or a graduated of an accredited school of Licensed Practical Nursing with a current license to practice as a LPN in the State of Louisiana.

• 2+ years of clinical experience in medical-surgical or other hospital specialty unit is preferred

• Electronic Medical/Health Record experience is required

• Home Health experience is preferred but not required

• Exceptional interpersonal, verbal, and written communication skills with concise, clear documentation skills

• Good judgement and critical-thinking skills

• Ability to work with limited supervision and to make decisions based on established policies and procedures

• Exceptional interpersonal, verbal, and written communication skills

• Customer service-oriented attitude/behavior

• Ability to navigate through multiple computer programs with ease including but not limited to Microsoft Office Suite (Word, Outlook, Excel, etc.)

• Highly organized and efficient with strong attention to detail

• Ability to multitask and prioritize in a fast-paced, ever-evolving environment

• Excellent verbal and written communication skills

• Ability to interact effectively with all levels of staff

Supervisory Responsibilities:
  • None

Supervision Received:



Works under general supervision of the Quality Improvement Supervisor and occasional direction of the Quality Improvement Director


Working Conditions:



Travel to provider offices and member homes is typically within the Monday through Friday 8:00 am to 5:00 pm timeframe

• Overtime may occasionally be required.

• Travel to physician offices and member homes will be required. Overnight stays are very rare.

• This position operates in a professional office environment with opportunity to work from home upon meeting training, eligibility, and performance requirements as deemed appropriate by management

• This is a full-time position (40 hours/week)

Physical Demands:


The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable qualified individuals with disabilities to satisfactorily perform these essential functions without causing an undue hardship for the employer.

While performing the duties of this job, the employee is required to remain in a stationary position for long periods of time and must frequently move about the office. The job duties also require the ability to drive and travel into provider offices and into member homes. The employee will constantly operate a computer and other office equipment such as phones, keyboards, printers, and copiers. The employee is regularly required to communicate with others via phone, email, etc. Occasionally, the employee is required to move up to 10 pounds and may, at times, be required to move up to 40 pounds.

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