LPN - Licensed Practical Nurse - QA Nurse Specialist

Live Well Homecare; Lancaster (Lancaster County); On-site; USD 32,000 - 48,000; Full time

Job summary

Live Well Homecare is seeking an experienced LPN to drive quality improvement initiatives through meticulous medical record reviews and adherence to NCQA/CMS standards.

The role includes managing member caseloads, intervening for non-compliance, and collaborating with primary care providers to enhance care coordination and preventive guidelines across multiple sites.

Qualifications

• Minimum of 3 years LPN experience with familiarity in medical record review and regulatory standards.

Responsibilities

• Conduct retrospective medical record reviews and document data accurately.
• Ensure compliance with NCQA/CMS and regulatory standards.
• Manage assigned member caseloads and intervene for non-compliance.
• Track progress using quality reports and data analytics.
• Educate/providers and staff on quality standards and care coordination.

Skills

LPN experience

Medical record review

Regulatory standards

Computer literacy

Job description

Role Overview:

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), and document data accurately.
• Manage assigned member caseloads, execute interventions for non-compliance, and 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, and assist in process improvements.
• Identify potential fraud or quality issues, and contribute to quality enhancement strategies.

Role Overview:

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), and document data accurately.
• Manage assigned member caseloads, execute interventions for non-compliance, and 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, and assist in process improvements.
• Identify potential fraud or quality issues, and contribute to quality enhancement strategies.

Qualifications & Skills:

Must have at least three years of LPN experience, familiarity with medical record review, regulatory standards, and computer literacy. Ability to work independently across multiple locations and document data accurately is essential.

Key Attributes:

Strong communication, collaboration, attention to detail, and commitment to quality healthcare are vital for success in this role.