HEDIS Nurse Specialist - Miami, United States - Borinquen Health Care Center

Description

Borinquen Medical Centers is located in Miami, FL and is seeking to hire a full time HEDIS Nurse Specialist.

The HEDIS Nurse Specialist will be a member of the Quality Department working in collaboration with the different clinical departments to close care gaps.

The position will utilize information collected from the EHR, health plan portals, and direct communication from health plans to identify, contact, and schedule visits with patients.

This position is also responsible for communicating directly with providers when care management, referrals, and other patient needs arise that inhibit the closure of care gaps.

As a key member of the Quality Department, this position must be comfortable with leading training and support meetings with clinical and provider staff groups that lead to better gap closure rates from the department.

Knowledge of and compliance with appropriate documentation and coding is a critical component of this positions success.

Additional roles for this position includes tracking patients recently discharged from the ER/UC, hospital, and other outpatient facilities; facilitating QI projects and exercises, such as PDSA and process mapping; and assisting as a clinical staff member during special care events

II. SKILLS, KNOWLEDGE, ABILITIES, TASKS AND RESPONSIBILITIES

Skills

Proficient in Microsoft Office, with emphasis on Word and Excel
Customer service oriented
Ability to multi-task
Talking to others to convey information effectively.
Active problem solver.
Logical thinking.
Knowledge of medical terminology.
Understanding of Medical Home standards.
Team player.
Exceptional organizational skills.
Knowledge of Medical Health Record (EHR).

Ability

Ability to understand data, review medical records and clinical quality procedures according to established protocols.
Ability to maintain quality, safety, and/or infection control standards.
Ability to run and analyze quality reports when needed.
Ability to track, monitor and validate data.

Tasks and Responsibilities

Core duties and responsibilities include the following:
Coordinating and completing HEDIS quality specific projects ensuring consistency with BHCC strategy, commitments, and goals
Maintain active, validated health plan specific rosters
Identify, call, and schedule patients to address gaps in care. This includes adults, pediatrics, specialty care, and People Living with HIV/AIDS
Track quality measures and provide training to clinical staff as needed to improve performance
Assist with Chronic Care management (CCM) Share Medical Appointments
Track hospitalization and ER/UC discharges and recall patients for continuity of care
Proactively seek resources to identify gaps on existing or quality projects as they arise
Performs other analyses to assist with documentation
Periodically audit records to confirm compliance with UDS, HEDIS, and NCQA standards
Ensures proper follow-through with clinical teams for patients who are engaged for care gap closure to minimize lost opportunities.
Verify and update patient registration information, including insurance, demographic and patient data when scheduling appointments
The ability to retrieve, communicate, present data and information both verbally and written
Provides paneling information provided to Health Plans is accurate and timely
Coordinates with Quality Manager on a weekly basis

Chart Audit:
Internal and External Chart Audits when requested
Perform and track call campaigns for non- compliant patients to increase access to care
Increase and track access to care for patients that have not attended in the last six months their primary care provider visit

Deliver cross-organizational trainings and audits related to areas of quality improvement; examples include correct blood pressure measurement and A1c screening.

Participate in special care events as a member of the clinical team.

III. ADDITIONAL RESPONSIBILITIES

Follows Borinquen Health Care Center's as well as governmental policies and procedures.
Supports QI-QA Plan and PLWHA Clinical Guidelines.
Supports clinical activities as needed
PDSA maintenance and support
QI project follow up and trend analysis

IV. JOB RELATIONSHIPS


Responsible:
Quality Manager.

Interrelationships:

Patient Care Team (Primary Care Physician, Clinical Managers, Nutritionists, Mental Health Specialist, Podiatrist, Chief Quality Officer, Chief Medical Officer and Director of Clinical Services, Ancillary Services and MCM) and Other Care Specialists.

V. MINIMUM REQUIREMENTS

Active nursing license in the State of Florida. RN Preferred
Well organized and Bilingual (Spanish and/or Creole).
Computer literacy with proficiency and expertise in Microsoft Office, including Outlook, Word, and Excel.
Ability to interact effectively with patients, administration, faculty, and staff.
Handle information with high level of confidentiality.
Considerable knowledge of standard concepts, practices, and procedures within a field.
Relies on limited experience and judgment to make decision, plan and accomplish goals.
Minimum 1 year of direct patient care in an outpatient setting.

Desired REQUIREMENTS

Bachelor's Degree.
Experience with case management, Ryan White/People Living With HIV/AIDS


BENEFITS
Medical/Dental/Vision/Short Term Disability
Company paid long term disability
Life insurance
401K Plan
Standard Paid Holiday's
Vacation and Sick Time
Amazing Team & Atmosphere