NEW JOB OPENING
CLINICAL QUALITY LPN
IN San Antonio, TX, USA!

Education:

• High school diploma or equivalent



Requirements:

• Current Licensed Vocational/Professional Nurse (LVN/LPN) license.

• Prior experience with HEDIS and STARs measures or similar regulatory reporting programs.

• Minimum of three (3) years of healthcare experience, preferably in a managed care environment.

• Minimum of three (3) years of experience in data analysis and quality chart reviews, with the ability to evaluate data and recommend improvements.

• Proficiency in Microsoft Office applications, including Excel, Word, and databases.



Preferred Requirements:

• Associate’s or Bachelor’s degree (completed or in progress).

• Two (2) or more years of direct experience working with HEDIS and STAR measures.





Job Duties:

• Analyze healthcare data to identify data integrity issues, gaps, and opportunities for improvement; document findings and recommendations.

• Monitor and trend HEDIS and STAR performance rates, identify barriers to improvement, and develop reports and interpretive exhibits.

• Identify members with care gaps and coordinate interventions such as patient education, counseling, and appointment scheduling to support gap closure.

• Conduct high-volume outbound calls using an auto dialer to address medication adherence, schedule pharmacy appointments, and obtain follow-up information from providers and members.

• Respond to inbound member calls, address inquiries, and route calls to appropriate departments when necessary.

• Follow established scripts and verify member demographic information to ensure accuracy.

• Document all member and provider interactions accurately in the appropriate systems.

• Collaborate with leadership to implement and execute quality improvement strategies.

• Support primary care providers (PCPs) and clinic staff with quality data collection and performance improvement efforts.

• Generate reports and monitor quality performance at the local level.

• Partner with PCPs and clinic teams to develop and implement strategies to improve quality outcomes and close care gaps.

• Maintain current knowledge of HEDIS, STARs, and related regulatory standards and guidelines.

• Perform additional duties as assigned.



Job Summary:

The Quality Coordinator LVN is responsible for coordinating and supporting HEDIS and STARs quality improvement initiatives. This role conducts telephonic outreach to educate patients on quality measures, including CAHPS and HOS components, and implements strategies to close identified care gaps. The Quality Coordinator evaluates the completeness and accuracy of clinical gap closures, maintains detailed documentation, and ensures compliance with current HEDIS and STARs regulatory standards and guidelines.

• **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.**