REMOTE HEDIS/Stars Clinical Quality RN

The Clinical Performance Quality (CPQ) Clinical Programs Operations team supports Care Delivery Organizations by delivering patient-centered, clinically collaborative telephonic outreach to help people live healthier lives. Our team focuses on the design, execution, and delivery of telephonic and digital engagement strategies designed to close Medicare STARS/HEDIS gaps in care, including medication adherence, care for older adults, A1c, Blood pressure and statin therapy in patient with diabetes and cardiovascular disease. Our interdisciplinary service delivery team is comprised of Pharmacists, Registered Nurses, Pharmacy Technicians, and Care Coordinators. The Registered Nurse will report into the Director of Clinical Programs. The Registered Nurse will perform telephonic, patient-centered clinical consults focused on Care for Older Adults annual pain and functional assessments. In addition, the RN will outreach telephonically to as assist with appointment scheduling. The RN will be required to meet or exceed established productivity and quality metrics, as well.

Primary Responsibilities:
• Strictly adheres to department’s metrics and established advanced protocols and to handle incoming contacts including, but not limited to, prescription refill requests, lab results, x-ray results, medical inquiries, patient education and referral requests.
• Primarily to make outbound calls and will help manage the inbound call queue from patients, patient representatives, providers and other medical staff, while strictly adhering to established protocols and scripting.
• Complete patient assessments Care for Older Adults Function Assessments
• Educate patients on health conditions and necessity of routine screening and assisting with appointment scheduling (A1c, Controlling Blood Pressure, Breast Cancer Screening, Colorectal Cancer Screening, Diabetic Eye Exam, etc.)
• Communicate with providers and offices to obtain needed evidence of completed lab work, screenings and care provided
• Assist patients with identification of and connectivity to community and program resources to assist with non-medical needs
• Document thoroughly all calls and actions taken within core systems

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• Must hold active, unrestricted Registered Nurse eNLC Compact licensure in state of residency
• 2 or more years of RN experience
• Experience with and extensive knowledge of the Medicare HEDIS/Stars measures
• Experience managing multiple complex, concurrent projects, using Microsoft office applications, including databases, word-processing, outlook, and excel spreadsheets with intermediate or better excel skills
• Can work Monday-Friday 9-6 CST

Billing and CPT coding experience
Clinical data abstraction experience
Bilingual preferred with preference given to Spanish and Vietnamese
Undergraduate degree preferred, post graduate degree highly preferred
Must currently have or be able to obtain additional RN licensure in one or more of the following states: Rhode Island, Massachusetts, Pennsylvania, Michigan, Illinois, California, Connecticut, Nevada, New York, Oregon
1 or more years of experience in HEDIS/Star programs, preferably in a clinical quality consultant role
2 or more years of Call Center or Telephonic Outreach experience
2 or more years of experience with data analysis and/or quality chart reviews, must be able to review paper and electronic medical records and chart

Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.