Provides care under the direct supervision of the Nursing Supervisor of Quality Improvement, utilizing physician approved patient protocols according to established standards and best practice guidelines. Facilitates the communication between patient/caregiver, physician and the outpatient care team to optimize health and wellness, reduce inpatient admission, reduce re-admissions and improve medical stability in the patient population served. Responsible for the coordination of HEDIS data gathering process by evaluating the quality and completeness of clinical documentation processes. Performs quality medical record reviews, assisting providers and staff in the improvement of clinical documentation process, identifying trends and gaps in care, maintaining accurate records of review activities, ensures all data submitted to the health plan meets the HEDIS technical specifications for medical records. Participates in the development and ongoing implementation of quality improvement activities by providing regular and ongoing physician/staff support and education.
Manages a caseload of 5,000-10,000 patients with identified gaps in care, in collaboration with the Health Care Team.
Request records from provider's offices as needed and perform a review of medical records for data collection, data entry, and quality monitoring including health plan and chart collection activities that close gaps in care.
Observe and Identify trends and potential strategies by collaborating with the leadership team, the provider administrative or clinical staff.
Track and trend barriers / challenges that exist to achieve better outcomes, including access to appointments, lack of follow up, or documentation.
Communicate scheduling challenges or trends that may negatively affect quality outcomes.
Activities may include data collection, data entry, quality monitoring, health plan and chart collection activities.
Navigate multiple EMR systems and obtain medical record sections supportive of HEDIS measures.
Maintains education / knowledge base of HEDIS / STARs.
Performs all other related duties as assigned
Works proactively to coordinate preventative/follow-up care for all patients receiving care from participating providers.
Complete comprehensive and thorough medical record review to extract medical record data per NCQA specifications for the health plan's HEDIS project
Schedules needed preventative services using evidenced based Physician approved protocols and documents the encounter.
Fosters a Team approach by working collaboratively with the member, family, PCP and other members of the healthcare team to ensure coordination of services.
Assists Nurse Navigators' in performing transition of care outreach to discharged patients to schedule return visit with the PCP per guidelines.
Employs knowledge of evidenced based guidelines to effectively communicate the importance of recommended procedures and testing.
Facilitates a collaborative approach with healthcare team for identification of and closure of care gaps.
Utilizes educational and behavioral change strategies to promote patient collaboration with the healthcare team.
Incorporates excellent written, verbal and listening communication skills, positive relationship building skills and problem solving into patient care coordination.
Performs duties as required or assigned for specific operational purposes for which they are qualified to perform.
Maintains all professional CEU's in compliance with State and Regulatory requirements.
Maintains confidentiality in all areas at all times.
Vocational/technical school graduate
Basic LVN Nursing skills
Knowledge of lab procedures and diagnostic testing
Ability to write clear documentation and ability to write detailed specifications
Solid organizational skills including attention to detail and multi-tasking skills
Basic computer skills
3 years clinical experience with at least 2 years in a primary care clinic preferred
HEDIS Experience preferred
Experience working in a physician, provider, and / or medical office
LVN/LPN License in the state of TX or where positions is located within the enterprise
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.