LVN Case Manager, CCM
$27.66 - $29.07 per hourHeritage Victor Valley Medical Group
- Engages physicians and office staff to facilitate discussions on HEDIS Part C Part D measures.
- Performs medical record reviews, abstraction and data-entry for HEDIS as part of HEDIS operations to close GAPs in care.
- Prepares reports and presentations outlining progress findings, and recommendations for management or regulatory bodies.
- Conducts monthly reviews in a timely manner and in accordance with established guidelines.
- Tracks compliance issues, trend data, prepares regular reporting to enhance performance related to HEDIS measures, and distributes to providers and internal teams.
- Stays informed about the HEDIS/STAR rating requirements and applicable annual updates.
- Prepares, submits, and bill findings to external stakeholders, ensuring adherence to reporting deadlines.
- Presents a summary of all tracking reports to identify areas of improvement monthly or upon request.
- Road travel required - 25% (Victor Valley surrounding cities)
- Performs other related duties as assigned.
- Education: High School graduate
- Licensure: Graduate from an accredited school for Vocational Nurses.
- Licensure: Current California LVN license.
- Experience: One year experience with HEDIS/STAR, medical records review.
- Knowledge: Required computer applications Excel, Word, Outlook, Power Point.
- Able to work in a multi-task, high demand environment.
- Driving: Driver's License and proof of Auto Insurance.
- Position is onsite.
Vacancy posted 2 days ago
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