HEDIS Clinical Review Nurse - LVN

Kinetic Personnel Group is currently recruiting for a HEDIS Clinical Review Nurse, LVN for a Public Health Plan (government entity). This position will be based in the Ontario, California area. This 5 billion-dollar a year government entity is renowned for its work in the community and being a great place to work

This position maintains a working knowledge of the organization’s current medical management systems, business processes, and workflows to support HEDIS and Quality-related activities. The HEDIS Clinical Review Nurse, LVN supports the CQI Supervisor and HEDIS Nurse RN with compliance with DHCS, CMS, and NCQA regulatory requirements related to Quality Improvement Systems.

This position is on a hybrid schedule (2 days remote, 3 office). This will start out as a temporary position with the possibility of converting to a permanent job after 6 months. Pay rate will go up in six months if converted to permanent position. A permanent position does include excellent retirement pension (CalPERS), ~10% yearly bonus, 6% contribution 453b and excellent government benefits including a generous Holiday/PTO schedule. This public health plan has been recognized as one of the best healthcare employers in the nation.

Job duties:

• Interpret, clarify, and implement changes accurately through the maintenance of current knowledge of HEDIS technical specifications.

• Demonstrate the ability to accurately apply technical specifications when performing chart reviews and communicate changes and clarifications to impacted business units within the organization, as appropriate to perform the primary function of medical record validation and support education/ outreach based on required NCQA standards.

• Support outreach and education projects related to HEDIS, Supplemental Data, and other quality improvement initiatives. Research and develop training materials, conduct presentations and information sessions, or provide targeted outreach about Historical Supplemental Data, NCQA HEDIS Technical Specifications, and other quality activities/medical record review projects.

Requirements:

• Three (3) or more years in healthcare administration in the areas of Utilization Management, Care Management, Quality Improvement or Quality Assurance, where medical record review, preferably in an HMO or managed care setting, is required.

• Minimum one (1) year clinical experience in an acute care facility, skilled nursing facility, home health or clinic setting required.

• High School Diploma or GED required.

• Possession of an active, unrestricted, and unencumbered Vocational Nurse (LVN) license issued by the California Board of Vocational Nursing and Psychiatric Technicians required.

• Working knowledge of NCQA HEDIS technical specifications, medical terminology, and health plan processes.

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