QA Nurse Specialist (LPN) - Work from Home, Northwest PA resident (Part-time, 20hrs/wk)
Location: North East
Posted on: June 21, 2022
Job Title: QA Nurse Specialist (LPN) - Work from Home, Northwest
PA resident (Part-time, 20hrs/wk)
Location: Erie, Pennsylvania
Job Category: LPN - Licensed Practical Nurse, Nursing and Nursing
Support, Geisinger Health Plan
Work Type: Part time
Department: GHP Quality Division
Date Posted: 06/03/2022
Job ID: R-29311
Job SummaryResponsible for managing annual and proactive HEDIS
(PAH) for compliant/ non-compliant population, Health
Choices/Commercial prenatal-postpartum (PNPP) population as
assigned. Responsible for and evaluated against success with
outreach to assigned HEDIS/PNPP member case load. Responsible for
retrospective medical record review to obtain clinical quality data
per the HEDIS/PNPP specifications set forth by the National
Committee for Quality Assurance (NCQA). Collaborates with the
Health Plan members and primary care providers in multiple practice
sites to facilitate clinical guideline adherence and coordinates
services as needed. Contributes to the design and implementation of
interventions developed by quality improvement workgroups to
achieve the goals and objectives defined within the Health Plan's
Quality Plan and Work plan.
- Demonstrates understanding of the regulatory agency standards
by participating in annual educational sessions.
- Manages assigned member caseload to execute appropriate
interventions to drive population outcomes and assist Health Plan
to attain high quality rates and rankings.
- Responsible for conducting medical record reviews including
physician progress notes, laboratory data, radiology and imaging
reports, consult notes, etc.
- at multiple primary care locations to collect criteria
established by CMS, NCQA and other regulatory agency standards with
little or no oversight by management.
- Demonstrates timely and accurate documenting of collected
medical record data in the Quality database per department
- Independently reviews targeted measures and collaborates with
practitioners or members to ensure follow-up care is provided
within the timeframe of established guidelines.
- Accurately documents relevant data into database.
- Tracks member compliance reports and executes appropriate
interventions for non-compliant members, including direct contact
with members, other primary care personnel and facilities as
- Educates and collaborates with primary care physicians and site
personnel regarding specific quality standards, targeted strategies
to drive quality outcomes, and the support available to them
through the Health Plan.
- Works with assigned provider office staff to educates members
regarding the importance of preventive health guidelines.
- Works collaboratively with Health Choices population as an
educator and clinical resource to encourage proactive process to
ensure optimal compliance with regulatory standards such as
prenatal and postpartum services, risk assessment, care
coordination, health and nutrition education and other preventive
- Participates as a voting member within the member appeals
process as appropriate and needed.
- Identifies opportunities for modifications in processes and
assists Management with implementation of the same.
- Responsible for reporting quality or potential fraudulent
issues identified through daily activities.
- Responsible for referring members for Health and Case
Management when appropriate.Work is typically performed in a
clinical environment. Accountable for satisfying all job specific
obligations and complying with all organization policies and
procedures. The specific statements in this profile are not
intended to be all-inclusive. They represent typical elements
considered necessary to successfully perform the job. Additional
competencies and skills outlined in any department-specific
orientation will be considered essential to the performance of the
job related to that position.
Position Details*Must be a resident of Northwest PA. Travel to
assigned provider offices and to assigned community outreach events
may be required.*Geisinger offers comprehensive suite of healthcare
benefits all starting day one of employment! -This includes
medical, prescription drug, vision and dental coverage. We also
offer up to $5,000 tuition reimbursement and 5% contribution to
your retirement plan.
EducationGraduate from Specialty Training Program-Nursing
ExperienceMinimum of 5 years-Nursing (Required)
Certification(s) and License(s)Licensed Practical Nurse - Default
Our Purpose & ValuesOUR PURPOSE & VALUES: Everything we do is about
caring for our patients, our members, our students, our Geisinger
family and our communities. KINDNESS: We strive to treat everyone
as we would hope to be treated ourselves. EXCELLENCE: We treasure
colleagues who humbly strive for excellence. LEARNING: We share our
knowledge with the best and brightest to better prepare the
caregivers for tomorrow. INNOVATION: We constantly seek new and
better ways to care for our patients, our members, our community,
and the nation. SAFETY: We provide a safe environment for our
patients and members and the Geisinger family We offer healthcare
benefits for full time and part time positions from day one,
including vision, dental and domestic partners. Perhaps just as
important, from senior management on down, we encourage an
atmosphere of collaboration, cooperation and collegiality. We know
that a diverse workforce with unique experiences and backgrounds
makes our team stronger. Our patients, members and community come
from a wide variety of backgrounds, and it takes a diverse
workforce to make better health easier for all. We are proud to be
an affirmative action, equal opportunity employer and all qualified
applicants will receive consideration for employment regardless to
race, color, religion, sex, sexual orientation, gender identity,
national origin, disability or status as a protected veteran.
Keywords: Geisinger, Erie , QA Nurse Specialist (LPN) - Work from Home, Northwest PA resident (Part-time, 20hrs/wk), Other , North East, Pennsylvania
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