LVN/LPN Quality HEDIS/STARs Coordinator San Antonio Texas

UnitedHealth Group - Floresville, TX

Full-time

Floresville, TX

Insurance Carriers and Related Activities

About the position

The LVN/LPN Quality HEDIS/STARs Coordinator is responsible for coordinating HEDIS and STARs data, educating patients on quality measures, and implementing strategies to close care gaps. This role involves telephonic outreach to patients, quality reviews, and maintaining compliance with regulatory standards. The coordinator will work closely with local leadership and clinic staff to enhance quality strategies and ensure accurate documentation of patient interactions.

Responsibilities

• Analyze data, evaluate for possible data integrity and data deficits and document findings
• Analyze and trend HEDIS/STAR rates, identify barriers to improvement of rates and create interpretive exhibits
• Identify patients with missing measures and work to close the measures through education/counseling, appointment setting, and other means as appropriate
• Conduct a high volume of outbound calls to members to discuss reasons for non-compliance to medication(s), schedule pharmacy telephonic appointments, and/or obtain important follow-up information from providers
• Answer inbound calls from members and assist them with their inquiries, routing calls to appropriate departments if necessary
• Follow system scripting and validate member demographic information
• Document the provider or member's record with accurate information obtained on the call
• Work closely with local leadership to execute quality strategies
• Support and assist PCPs/clinics with quality data collection
• Provide reports and monitor performance at the local level
• Engage PCP and clinic staff in developing strategies to close quality gaps
• Maintain education/knowledge base of HEDIS/STARs standards and guidelines
• Perform all other related duties as assigned

Requirements

• Licensed Vocational/Professional Nurse
• 3+ years of healthcare experience to include experience in a managed care setting
• 3+ years of experience with data analysis/quality chart reviews, able to review data and provide recommendations for improvement
• HEDIS/STAR experience or participation with similar regulatory reporting
• Experienced using Microsoft office applications, including databases, word-processing, and excel spreadsheets

Nice-to-haves

• 2+ years of college, in pursuance of a Bachelor's or Associate's degree
• 2+ years of experience working with HEDIS/STAR measures

Benefits

• Opportunities for professional development
• Recognition for performance
• Supportive work environment