Licensed Practical Nurse (Lpn)

Reporting to our Quality Manager Advanced Practice Provider, the Quality Research Nurse will be responsible for performing an initial review of patient records from various EMRs to assist in closing quality gaps for our patients. They will be required to navigate our evolving partner platform, Reveleer, along with various clinic EMRs, payer portals and our internal CoOp clinical analytics platform, all utilized for quality measure management. The Quality Research Nurse will need to develop a strong understanding of HEDIS (Healthcare Effectiveness Data and Information Set) measure guidelines established by NCQA and CMS, including measurement eligibility criteria, exclusion criteria and documentation required to close quality measures.

The Quality Research Nurse will be a part of a team, working closely with the VPs of Quality, QM APP and Director of Quality as well as members of the central operations team, clinical team and field health navigators as necessary. The ideal candidate will possess a meticulous attention to detail, deep organizational skills, and must stay abreast of all database updates, and other day-to-day responsibilities as assigned. The Quality Research Nurse must also possess excellent communication skills to answer questions for internal stakeholders, solve record-reconciliation issues, and keep the organization's leadership team updated with relevant information.

Job Duties

• Accessing and navigating electronic medical records (EMRs), payer portals, and Reveleer quality platform
• Promote effective working relations and work effectively as part of a team to facilitate the department's ability to meet its goals and objectives
• Entering and reconciling clinical information in relevant databases
• Contribute to team results by meeting individually assigned goals and deadlines
• Research, record findings, and communicate effectively with supervisor to achieve optimum performance
• Securely handle partner data and patient health information
• Scanning through multiple sources of data to identify pertinent clinical information to be extracted and recorded
• Perform other duties as assigned to support Main Street Health's Mission, Vision, and Values
• Correct errors and organize the information in a manner that will optimize swift and accurate capturing of detailed data

Minimum Qualifications

• High school diploma or equivalent
• Excellent interpersonal and communication skills
• 1+ years' experience in a relevant field
• Licensed Practical Nurse (LPN) certification

• A sense of urgency and quality toward completion of duties
• Strong team player
• Excellent organization and time management skills
• Knowledge of MS Office Products including Excel, Word, and Outlook
• Ability to learn quickly, build and maintain long term relationships and work under moderate supervision
• Ability to concentrate for lengthy periods and perform accurately with adequate speed
• Maintain patient and partner confidentiality, always abiding by Health Insurance Portability and Accountability Act (HIPAA) regarding Patient Health Information (PHI)
• Meticulous attention to detail
• Proficient touch-typing skills

Preferred Qualifications

• Understanding of medical terminology and insurance laws/guidelines
• Previous experience in a medical setting and/or experience with an electronic medical record
• Understanding of HEDIS quality measures