Quality Interventions Nurse
Location
Garden City, NY | United States
Job description
HealthCare Partners, IPA and HealthCare Partners, MSO together comprise our health care delivery system providing enhanced quality care to our members, providers and health plan partners. Active since 1996, HealthCare Partners (HCP) is the largest physician-owned and led IPA in the Northeast, serving the five boroughs and Long Island. Our network includes over 6,000 primary care physicians and specialists delivering services to our 125,000 members enrolled in Commercial, Medicare and Medicaid products. Our MSO employs 200+ skilled professionals dedicated to ensuring members have access to the highest quality of care while efficiently utilizing healthcare resources.
HCP’s vision is to be recognized by members, providers and payers as the organization that delivers unsurpassed excellence in healthcare to the people of New York and their communities. We pride ourselves on selecting the most qualified candidates who reflect HCP’s mission of serving our members by facilitating the delivery of quality care. Interested in joining our successful Garden City Team? We are currently seeking
Quality Intervention Nurse! Position Summary: The Medicaid Quality Interventions Nurse (QIN) is responsible for clinical reviews, some on-site and telephonic data collection, and the abstracting and data entry of HEDIS data from medical records. The QIN will serve as the subject matter expert for the Quality Team and providers on topics pertaining to chart reviews and documentation as well as HEDIS/QARR/Stars technical specifications.
Essential Position Functions/Responsibilities:
- Manage HealthCare Partners (HCP) providers’ quality performance as it relates to clinical documentation and coding for HEDIS/QARR.
- Educate providers and their office staff on relevant clinical guidelines and maintain knowledge of clinical standard of care updates.
- Perform root cause analysis for coding/documentation inaccuracies; create work plans per provider to measure office progress as needed.
- Initiate, facilitate and attend provider meetings to provide feedback on coding and chart documentation improvements, successes and raise issues and concerns to ensure optimal outcomes and appropriate follow up.
- Review and abstract medical data from diverse sources including but not limited to inpatient and outpatient medical records and immunization registries for clinical data elements specific to HEDIS/QARR measure specifications.
- Maintain and keep up-to-date on annual HEDIS/QARR technical specifications updates and understand underlying clinical justification for each Quality Measure.
- Develop and conduct internal trainings for all impacted staff and departments.
- Document all medical record abstractions into various electronic record keeping systems as necessary.
- Comply with HCP appropriate procedures for scheduling, requesting, and reviewing records on-site/via phone/email/fax.
- Maintain applicable documentation retrieval, abstraction, and accuracy standards.
- Retain Provider Partnerships; provide education to providers and office staff on Quality Measures and appropriate documentation techniques as appropriate.
- Partner with Network, Quality Field Specialists and other Provider focus teams to maximize member outreach for preventive services and chronic disease management, as needed.
- Participate in various HCP initiatives and/or processes as directed by supervisor.
- Assist in developing member and/or provider educational materials in relation to HEDIS, QARR and/or other health communications.
- Serve as subject matter expert on Quality Measures and clinical guidelines for the Quality Team.
- Perform other duties or responsibilities as necessary or assigned.
Qualification Requirements:
Skills, Knowledge, Abilities - Superior in t erpersonal s k il l s with the a bility to work collaborative l y and build p o si t ive relationships with key provider partne r s and team members across the organiza t ion as well as influe n ce with and without formal authority to drive performance outcomes.
- Ability to w o rk in a multidisciplinary team in a f a s t -paced e n vironment with c h an g i n g prioritie s .
- Strong attention to detail with highly effec t i ve written and verba l communication and pr e sentation skills.
- Posse s s s o lid r e s ult s - o r ie n ted process improvement c a pabiliti e s.
- Exceptional p r o bl em sol v i n g/critica l thinking s kills and ability to learn new s k ills quick l y; s elf-starter.
- Must have a working knowledge of MS Excel, W o r d , P ow e r P o i n t
- Must have experience working in electronic medical record systems
Training/Education:
- RN or LPN license in good standing
- Driver License in good standing
Experience:
- 2 ye a r s HEDIS experience in both Medicare and Medicaid
- 2+ yea r s of provider e n g ag e m e nt e x per i e n ce, pr e f e r r e d
- K n o w l e d ge o f H E DI S / QARR r e qu i r em en t s for Medicaid li n e of business i n c ludi n g med i c a l rec o rd review a n d /or reporting p r oc e s s e s, p r ef e r r ed
Salary:
- Annual Base Compensation for RN: $90,000 - $110,000
- Annual Base Compensation for LPN: $70,000 - $85,000
- Bonus Incentive: Up to 5%, based on organizational performance
HealthCare Partners, MSO provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, HealthCare Partners, MSO complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
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