LVN Case Manager

Primary Job Duties and Responsibilities:

• 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.

The pay range for this position at commencement of employment is expected to be between $27.66 and $29.07/hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, skills, and experience. The total compensation package for this

Qualifications:

• Education: High School graduate
• Education: 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.