Quality Specialist LPN

Job Description

Job Description

Thank you for expressing your interest in pursuing a career with Valley Medical Group. We are a provider-owned, multi-specialty group. We proudly serve a diverse community of over 55,000 patients at four locations throughout the Pioneer Valley.

Valley Medical Group is looking for a Quality Specialist Licensed Practical Nurse to join our Family Practice team and work in our Greenfield Health Center. If you are looking for a dynamic environment, this is your opportunity!

NO NIGHTS! NO HOLIDAYS!

Position: Quality Specialist LPN

Location: Greenfield, MA

Hours: 40 hours, Monday-Friday generally between 7:30am and 4:00pm. Hours may vary depending on department needs. Exact schedule to be discussed at time of interview.

As a Quality Specialist LPN, you will be assigned projects and roles that contribute to the quality program, provide chart audit for risk adjustment projects, provide review and data entry into EMR for the accurate documentation of quality measures and preventative services, review and maintain filing and follow up for patient experience, complaint and incident reporting program as well as targeted projects to provide guidance to providers for appropriate diagnostic coding for risk adjustment that represents each patient’s level of chronic illness.

Job Responsibilities:

• HCC coding and risk adjustment review and analysis: review patients for targeted diagnosis gaps and update the EMR to reflect appropriate HCC diagnosis, and perform chart prep for the upcoming appointment.
• Review/abstract information from transferred medical records to update EMR quality measures and preventative services for new patient charts
• Coordinate transition of care follow up phone calls with case management programs. Perform follow up phone calls, TCMS documentation for all appropriate patients not managed by risk contract case management staff. Update medication lists and problem lists as appropriate, schedule TCMS or Hospital/ER/SNF follow up appointments with PCP.
• Liaison with health plan quality and HCC programs, updating HCC and preventative services in the health plan software platform to meet metrics for performance.
• Review and file Incident and complaint forms. Follow up with appropriate managers and supervisors for outstanding or incomplete forms.
• Review and manage patient experience data, initiate the patient complaint and incident review process for any comments provided less than 70% willingness to recommend, or comments that constitute a patient complaint regarding customer service or care.
• Perform chart audit and data abstraction as needed for health plan risk contracts
• Collaborate with other departments and key personnel including the Quality Physician, Quality Director, Health Information Coordinator, case management staff and clinical supervisors.
• Other Duties as assigned: Quality LPNs perform special projects as needed that include research and review of EMR data.

Required Qualifications:

• Current Massachusetts LPN License (or able to obtain licensure in MA)
• Graduate of an accredited school of nursing (Associates or Bachelors)
• Knowledge of chronic diseases, medications, disease management guidelines, medical terminology, ICD-10 coding, and knowledge of Hierarchal Condition Categories.
• Minimum of 2 years outpatient medical experience
• Current CPR certification
• Strong organizational skills that reflect ability to perform and prioritize multiple tasks seamlessly with excellent accuracy and attention to detail

Additional Preferred Qualifications:

• Athena experience a plus

If you do not meet all of the preferred qualifications, we strongly encourage you to apply and/ or inquire. We often have multiple open positions and could consider you for another opportunity with our organization.

Valley Medical Group offers:

• Medical, Dental & Vision Plans
• 401(k) Plan with Company Match
• Health Savings Account & Flexible Spending Account
• Generous Paid Time Off
• 7 Paid Holidays
• Company-Paid Long-Term Disability Insurance
• Company-Paid Life Insurance
• Voluntary Life, Accident and Critical Illness Insurance Options
• Company Wellness Program
• Employee Assistance Program
• Free On-Site Parking

We Value Employee Engagement and Inclusive Practices

Valley Medical Group (VMG) seeks to recruit, develop, and retain the most qualified workforce from a diverse candidate pool. We strive for every VMG staff person and provider to feel valued and be treated fairly, respectfully, and with dignity. We expect our employees to conduct themselves in a professional manner that promotes equal opportunity and prohibits unlawful discriminatory practices, including bias and harassment.

Fostering inclusion and belonging among our employees is critical to our success in providing high-quality patient care rooted in evidence-based practices and health equity. We have several initiatives that prioritize the employee experience, from an annual assessment of employee engagement to staff recognition events, various feedback mechanisms, and committees that promote an inclusive workplace.