Quality Specialist LPN

GREENFIELD Quality Specialist LPN 40 hours, Monday-Friday generally between 7:30am and 4:00pm. Hours may vary depending on department needs. Exact schedule to be discussed at time of interview. As a Quality Specialist LPN, you will be assigned projects and roles that contribute to the quality program, provide chart audit for risk adjustment projects, provide review and data entry into EMR for the accurate documentation of quality measures and preventative services, review and maintain filing and follow up for patient experience, complaint and incident reporting program as well as targeted projects to provide guidance to providers for appropriate diagnostic coding for risk adjustment that represents each patient?s level of chronic illness. Job Responsibilities: HCC coding and risk adjustment review and analysis: review patients for targeted diagnosis gaps and update the EMR to reflect appropriate HCC diagnosis, and perform chart prep for the upcoming appointment. Review/abstract information from transferred medical records to update EMR quality measures and preventative services for new patient charts Coordinate transition of care follow up phone calls with case management programs. Perform follow up phone calls, TCMS documentation for all appropriate patients not managed by risk contract case management staff. Update medication lists and problem lists as appropriate, schedule TCMS or Hospital/ER/SNF follow up appointments with PCP. Liaison with health plan quality and HCC programs, updating HCC and preventative services in the health plan software platform to meet metrics for performance. Review and file Incident and complaint forms. Follow up with appropriate managers and supervisors for outstanding or incomplete forms. Review and manage patient experience data, initiate the patient complaint and incident review process for any comments provided less than 70% willingness to recommend, or comments that constitute a patient complaint regarding customer service or care. Perform chart audit and data abstraction as needed for health plan risk contracts Collaborate with other departments and key personnel including the Quality Physician, Quality Director, Health Information Coordinator, case management staff and clinical supervisors. Other Duties as assigned: Quality LPNs perform special projects as needed that include research and review of EMR data. Required Qualifications: Current Massachusetts LPN License (or able to obtain licensure in MA) Graduate of an accredited school of nursing (Associates or Bachelors) Knowledge of chronic diseases, medications, disease management guidelines, medical terminology, ICD-10 coding, and knowledge of Hierarchal Condition Categories. Minimum of 2 years outpatient medical experience Current CPR certification Strong organizational skills that reflect ability to perform and prioritize multiple tasks seamlessly with excellent accuracy and attention to detail Additional Preferred Qualifications: Athena experience a plus