NEW JOB OPENING
HEDIS CLINICAL QUALITY LPN
IN Remote, USA!

Education:

Required Education: High School Diploma plus completion of an approved practical nursing program

Preferred Education: Associate degree or bachelor’s/undergraduate degree

Required License: Active, unrestricted LPN or LVN license





Required Qualifications

• Active LPN/LVN license.

• 1+ year of provider outreach experience.

• 1+ year of HEDIS® and/or STAR experience.

• 2+ years of experience with data analysis and/or quality chart reviews, including the ability to review medical records and assess documentation for completeness.

• Strong medical record review and clinical documentation skills.

• Excellent written and verbal communication skills.

• Experience with Microsoft Office, including Word, Excel, spreadsheets, and database applications.

• Ability to work independently in a remote environment while managing multiple systems, records, and deadlines.



Preferred Qualifications

• Associate degree.

• Bachelor’s/undergraduate degree or equivalent experience.

• Certified Professional Coder (CPC) certification.

• 1+ year of call center experience.



We are seeking a Clinical Quality LPN to support HEDIS® and STAR quality initiatives through medical record review, data collection, provider outreach, and quality gap closure. This position will work remotely within electronic health record (EHR) systems to identify and collect clinical documentation, assess medical records for completeness and accuracy, and ensure appropriate data is captured to support HEDIS®/STAR measures.

The ideal candidate will have an active LPN/LVN license along with previous experience in HEDIS®/STAR, provider outreach, medical record review, and healthcare data analysis.



Key Responsibilities

• Data mine directly within electronic health record (EHR) systems to identify documentation needed to close quality gaps in care.

• Review and abstract medical record information into designated applications and databases.

• Navigate multiple clinical documentation systems to locate medical record information supporting HEDIS® and STAR quality measures.

• Conduct outreach to provider offices to request medical records and other required clinical documentation.

• Follow up with provider offices that have not responded to record requests or have submitted incomplete documentation.

• Serve as a subject matter resource to provider offices regarding HEDIS® data collection and documentation requirements.

• Analyze medical record information for potential data integrity issues, missing information, or documentation deficiencies and document findings.

• Support hybrid chart chase activities by requesting additional medical records from provider offices as needed.

• Maintain current knowledge of HEDIS® and STAR standards, guidelines, and documentation requirements.

• Perform additional quality-related responsibilities as assigned.





Work Environment

This is a fully remote position. Business casual attire is expected when participating in video meetings.



Interview Process

Candidates will initially be interviewed and vetted by the staffing vendor. Qualified candidates will then be presented to the hiring manager with a resume and candidate summary for review.

• **Only those lawfully authorized to work in the designated country associated with the position will be considered.**

• **Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements.**