RN LPN Nurse

Job Description

Job Description

The ideal candidate is experienced in patient outreach, care coordination, population health, social services, health coaching, or quality improvement and possesses a strong understanding of outpatient healthcare operations and HEDIS-related activities.

Key Responsibilities

·      Serve as a trusted advocate and liaison between members, families, healthcare providers, and community resources.

·      Conduct telephonic and face-to-face outreach to engage members and address identified care gaps.

·      Schedule preventive care appointments and coordinate follow-up services to improve healthcare compliance.

·      Educate members and families regarding preventive healthcare, treatment plans, and available community resources.

·      Partner with provider offices and clinical teams to improve quality metrics and patient outcomes.

·      Support HEDIS and NCQA quality initiatives through member engagement, chart review support, and provider collaboration.

·      Assess provider performance data and identify opportunities for quality improvement.

·      Collaborate with Provider Relations, Care Management, Quality, Customer Service, and Operations teams to resolve member issues and improve service delivery.

·      Arrange transportation and other support services to ensure member access to care.

·      Maintain accurate and timely documentation of all member interactions and outreach efforts.

·      Refer members to Case Management, Disease Management, Behavioral Health, or other appropriate programs as needed.

·      Participate in special projects and departmental initiatives supporting organizational objectives.

·      Adhere to all Centene, MHS, regulatory, and compliance standards.

Day-to-Day Activities

·      Work onsite within assigned FQHC/provider locations.

·      Conduct member outreach and schedule appointments to close gaps in care.

·      Meet with members and families to discuss barriers to healthcare access.

·      Collaborate with clinic staff to improve quality performance measures.

·      Track outreach activities and document interactions within required systems.

·      Participate in weekly team meetings and quality improvement discussions.

·      Travel locally between assigned clinics as needed.

Required Qualifications

Education

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

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