Langley Health Services
We are looking for a full-time Care Coordinator who is a robust team player. We hire to retire. Join our awesome team of professionals today!
- health insurance (medical, dental, vision)
- FREE medical co-pays
- paid time off
- eight paid holidays
- company paid life insurance and short term disability
Primary responsibilities include but are not limited to:
- Function as Care Coordinator/Case Manager for adult and pediatric populations
- Learn and understand the HEDIS technical specifications for all HEDIS/Stars measures for Part C and Part D
- Participate in monthly meetings with insurance plans to discuss compliance on HEDIS measures and receive education regarding measures
- Coordinate, complete, and update management on all HEDIS processes and results
- Organize and maintain a plan of action to improve HEDIS scores
- Request and evaluate reports for member compliance and improvement opportunities for each HEDIS measure
- Ensure compliance by conducting quality audits and maintaining all data and process controls
- Works closely with internal and external teams to ensure high quality scores and quality rankings for providers
- Works as part of a team to ensure consistent, timely, and appropriate completion of HEDIS/Stars measures for Part C and Part D
- Provide education regarding HEDIS measures and Care Gaps content and respective EHR workflows to patients, providers and support staff teams
- Communicate with providers, office staff, internal teams, health plan teams, and others involved with insurance plans and HEDIS measures to ensure high compliance ratings on measures
- Ensure effective tracking of test results, medication management, and adherence to follow-up appointments
- Contact patients to discuss gaps in care to be addressed and schedule appointments for this purpose
- Document care gaps for providers and support staff so the care gap can be met during patient visit, if appropriate
- Maintain productivity level as determined by the Director of Nursing and Operations
- Participates in professional development activities to stay current with trends, practices and requirements for HEDIS and MRA
- Maintain HIPAA with confidential approach to patient information at all times.
- Collect data and produce Quality Improvement reports to participate in the Quality Improvement Committee.
- Ensure effective and efficient communication among and between departments.
- Collaborates with Associate Chief Operating Officer, Director of Operations, Chief Operations Officer, Chief Medical Officer and staff to facilitate and resolve patient care issues
- Travel to other LHS locations may be required
- May be required to provide clinical staff coverage if critical shortage exists
- Other job duties as appropriate and assigned by supervisor
- Associate’s or Bachelor’s degree in Nursing or healthcare related field preferred; direct care experience may be substituted for degree at the discretion of management.
- Current Florida Registered or Practical Nursing license without violations
- Current BLS certification
- Previous Care Coordination, Case Management or Home Health experience-preferred
- Experience with navigation of local medical and social support systems -preferred
- Previous experience with health systems and data reports-preferred
- Computer proficient
- Excellent interpersonal, communication, and organizational skills
To apply please email your resume to the reply link or fax to 855-832-3504, attention Human Resources. We are an equal opportunity employer and drug-free workplace
To apply for this job email your details to firstname.lastname@example.org