LPN - Licensed Practical Nurse - QA Nurse Specialist

About the role

This position involves managing quality improvement initiatives by reviewing medical records, supporting HEDIS and prenatal/postpartum measures, and collaborating with healthcare providers to enhance care outcomes.

Responsibilities

• Conduct retrospective medical record reviews
• Ensure compliance with regulatory standards (NCQA, CMS)
• Document data accurately
• Manage assigned member caseloads
• Execute interventions for non-compliance
• Track progress using quality reports
• Educate and collaborate with primary care providers and staff on quality standards, preventive health guidelines, and care coordination
• Participate in member outreach
• Support case management referrals
• Assist in process improvements
• Identify potential fraud or quality issues
• Contribute to quality enhancement strategies

Qualifications

• At least three years of LPN experience
• Familiarity with medical record review
• Knowledge of regulatory standards
• Computer literacy
• Ability to work independently across multiple locations
• Ability to document data accurately

Skills

• Strong communication
• Collaboration
• Attention to detail
• Commitment to quality healthcare