Licensed Practical Nurse

Job Description

Job Description

Key Responsibilities

Member Outreach & Care Coordination

·      Conduct telephonic and face-to-face outreach to members regarding preventive care needs and identified gaps in care.

·      Schedule medical appointments and coordinate follow-up services.

·      Assist members with transportation arrangements and appointment reminders.

·      Educate members and families on health concerns, preventive care, and available healthcare resources.

·      Identify barriers to care and coordinate appropriate solutions.

Provider & Clinic Support

·      Serve as the primary liaison between members, provider offices, and healthcare teams.

·      Work directly within provider practices to support quality and performance improvement initiatives.

·      Collaborate with clinic staff to improve healthcare outcomes and member engagement.

·      Support provider offices in achieving HEDIS and quality performance goals.

Quality Improvement & HEDIS Activities

·      Review and analyze quality performance metrics.

·      Support HEDIS-related initiatives, chart reviews, and gap closure efforts.

·      Educate provider staff on NCQA/HEDIS measures and appropriate documentation practices.

·      Assist in identifying opportunities for quality improvement and risk adjustment initiatives.

Documentation & Reporting

·      Accurately document member interactions, outreach activities, and care coordination efforts.

·      Maintain records in compliance with organizational and regulatory requirements.

·      Track outreach activities, appointments scheduled, and quality improvement outcomes.

Cross-Functional Collaboration

·      Partner with Provider Relations, Customer Service, Case Management, and other internal departments.

·      Refer members to Case Management or Disease Management programs when appropriate.

·      Participate in team meetings and special projects as assigned.

Required Qualifications

Education & Experience

·      Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Social Work, Health Administration, or a related healthcare field

OR

·      Equivalent combination of education and experience totaling at least 4 years.

Additionally:

·      Minimum 2 years of experience in one or more of the following:

o  Direct patient care

o  Care coordination

o  Social work

o  Health coaching

o  Quality improvement

o  Managed care environment

Required Skills

·      Understanding of outpatient clinic operations, preferably within an FQHC environment.

·      Experience supporting HEDIS initiatives, chart abstraction, or quality improvement programs.

·      Strong communication and relationship-building abilities.

·      Ability to work independently in a field-based setting.

·      Organizational and time management skills.

·      Proficiency with documentation and healthcare systems.