Call Center LVN/LPN

An employer is seeking a Call Center LVN/LPN to work in an enterprise level environment in the healthcare industry. This call center for one stop shop for anything a patient could be having issues with. You would be getting calls based of CAHPS (Consumer Assessment of Healthcare Providers and Systems) and HOS scores (Health Outcomes Survey). You would provide some of the clinical counseling for some of the HOS measures. You will help close the gaps with appointment scheduling, test, referrals, complaints, escalations, medication adherence measures, refills etc. Anything it takes a patient from being unhappy to as happy as we can get them. The call range can take 10 min to a couple of hours whether that’s connecting the patients to their health plan, their providers office, their nurse, their home health, outside resources to help with social determinacies of health, and APS.

Requirements:

• Need current active Licensed Vocational/Professional Nurse License
• Prior HEDIS/STAR experience or participation with similar regulatory reporting.
• Three or more years of healthcare experience to include experience in a managed care setting.
• Three or more years of experience with data analysis/quality chart reviews. Must be able to review data and provide recommendations for improvement.
• Experienced using Microsoft office applications, including databases, word-processing, and excel spreadsheets.

Plusses:

• Two or more years of college, in pursuance of a Bachelor’s or Associate’s degree.
• Two or more years of experience working with HEDIS/STAR measures.

This position is responsible for the coordination of HEDIS and STARs data. This role is responsible for education to the patient on quality measures and coordinates strategies for closing gaps. The Quality Coordinator LVN, through telephonic outreaches will educate patients on CAHPS & HOS components while working to close other HEDIS gaps for patients. Evaluates the quality and completeness of clinical gap closures by performing quality reviews with patients, maintaining clinical documentation, and accurately records of their review activities. The Quality Coordinator LVN will maintain up-to-date knowledge of regulatory (HEDIS/STARs) standards and guidelines.

Essential Job Functions

Analyze data, evaluate for possible data integrity and data deficits and document findings.

Analyze and trend HEDIS/STAR rates, identify barriers to improvement of rates and create interpretive exhibits.

Identifies patients with the missing measures and works to close the measures through education/counseling, appointment setting, and other means as appropriate.

Conduct a high volume of outbound calls to members to discuss reasons for non-compliant to medication(s), schedule pharmacy telephonic appointments, and/or obtain important follow up information from providers. Outbound calls are made primarily using an auto dialer requiring precision to detail and adaptability to type of response needed.

May answer inbound calls from members and assists them with their inquiries. Routes calls to appropriate department if necessary.

Follows system scripting and validates member demographic information.

Documents the provider or member's record with accurate information obtained on the call.

Works closely with local leadership to execute quality strategies.

Supports and assists PCPs/clinics with quality data collection.

Provides reports and monitors performance at local level.

Engages PCP and clinic staff in developing strategies to close quality gaps.

Maintains education/knowledge base of HEDIS/STARs standards and guidelines.

Performs all other related duties as assigned.

Pay: $20.00 - $25.00 per hour

Application Question(s):

• Do you have prior HEDIS/STAR experience?
• Do you have 3 years of experience with data analysis/quality chart reviews (Must be able to review data and provide recommendations for improvement)?

Experience:

• Nursing: 3 years (Required)

License/Certification:

• LPN/LVN License (Required)

Work Location: In person

Salary : $20 - $25