What are the responsibilities and job description for the Quality Program LVN Case Manager position at HERITAGE VICTOR VALLEY MED GRP VICTORVILLE CLINIC?
Company Description
HERITAGE VICTOR VALLEY MED GRP VICTORVILLE CLINIC is a dedicated healthcare provider located in Victorville, California. The clinic specializes in offering high-quality medical services to the local community, focusing on patient-centered care and wellness. Situated on Hesperia Road, the organization is committed to fostering health and well-being through comprehensive healthcare services. Join our team and contribute to our mission of delivering exceptional care to our patients.
Role Description
Quality Programs
LVN Case Manager Full-Time
Job description:
Summary
Under the direction of the Quality Programs Director, the Quality Programs LVN Case Manager plays a key role in supporting HEDIS and quality reporting initiatives, ensuring healthcare providers excel in meeting Quality Measures consistent with the CMS Star Rating Program. This role is responsible for ensuring the accuracy, completeness, and compliance of medical record abstraction and data validation processes that impact HEDIS measure performance, regulatory audits, and quality improvement efforts. The Quality Programs LVN Case Manager reviews medical records across various provider EMR systems, Paper charts repositories, and
accurately documents findings and ensures adherence to technical specifications. Additional
responsibilities include contributing to departmental workflows, supporting annual training, and advancing
broader quality initiatives. This position will require strong organization, communication skills, and feedback
to achieve maximum CMS Star Ratings every year. Assists with other clerical duties as required.
Responsibilities
• Engages physicians and office staff to facilitate discussions on HEDIS Part C Part D measures.
• Performs medical record reviews, abstraction and data-entry for HEDIS as part of HEDIS operations
to close GAPs in care.
• Prepares reports and presentations outlining progress findings, and recommendations for
management or regulatory bodies.
• Conducts monthly reviews in a timely manner and in accordance with established guidelines.
• Tracks compliance issues, trend data, prepares regular reporting to enhance performance related to
HEDIS measures, and distributes to providers and internal teams.
• Stays informed about the HEDIS/STAR rating requirements and applicable annual updates.
• Prepares, submits, and bill findings to external stakeholders, ensuring adherence to reporting
deadlines.
• Presents a summary of all tracking reports to identify areas of improvement monthly or upon request.
• Road travel required - 25% (Victor Valley surrounding cities)
• Performs other related duties as assigned.
Qualifications
• Education: High School graduate
• Licensure: Graduate from an accredited school for Vocational Nurses.
• Licensure: Current California LVN license.
• Experience: One year experience with HEDIS/STAR, medical records review.
• Knowledge: Required computer applications Excel, Word, Outlook, Power Point.
• Able to work in a multi-task, high demand environment.
• Driving: Proof of valid Driver’s License and current Vehicle Insurance
• Position is onsite.