LPN - Licensed Practical Nurse - QA Nurse Specialist

Health Wealth Safe, Inc.; Bethlehem (Northampton County); On-site; USD 30,000 - 41,000; Full time

Job summary

Health Wealth Safe, Inc. is seeking an experienced Licensed Practical Nurse to oversee quality care initiatives and support HEDIS and prenatal/postpartum measures.

The role involves reviewing medical records, documenting data in a quality database, and collaborating with providers to improve health outcomes. Responsibilities include managing member caseloads, coordinating interventions, and ensuring compliance with NCQA and CMS standards.

Qualifications

• Graduate from a Specialty Training Program in Nursing (required).
• Strong communication, collaboration, and analytical skills are essential for success in this role.

Responsibilities

• Manages quality care initiatives and supports HEDIS and prenatal/postpartum measures.
• Conducts medical record reviews and documents data accurately in the quality database.
• Collaborates with providers and members to improve health outcomes.
• Manages member caseloads and executes targeted interventions.
• Ensures compliance with regulatory guidelines such as NCQA and CMS.
• Promotes preventive health and guideline adherence with staff and members.
• Identifies opportunities for process improvements and quality enhancements.

Skills

LPN experience

Medical record review

Regulatory standards

Computer skills

Education

Specialty nursing program

Job description

Role Overview

This position involves managing quality care initiatives by supporting HEDIS and prenatal/postpartum measures, conducting medical record reviews, and collaborating with providers and members to improve health outcomes.

• Minimum of three years of LPN experience, familiarity with medical record review, regulatory standards, and computer skills.
• Responsible for managing member caseloads, executing interventions, and ensuring compliance with regulatory guidelines such as NCQA and CMS.
• Conducts detailed medical record reviews across multiple primary care sites, documenting data accurately in the quality database.
• Works proactively with providers to facilitate follow-up care, educate staff and members on preventive health, and promote guideline adherence.
• Participates in quality improvement activities, tracks compliance reports, and identifies opportunities for process enhancements.
• Refers members to case management and reports quality or fraudulent issues as needed.
• Requires knowledge of healthcare standards, excellent documentation skills, and the ability to work independently in a clinical environment.

Qualifications

Graduate from a Specialty Training Program in Nursing (required). Strong communication, collaboration, and analytical skills are essential for success in this role.