LPN – Licensed Practical Nurse, QA Nurse Specialist

This is a fully remote position, open to applicants in Pennsylvania.

📋 Description

• Oversee annual and proactive HEDIS (PAH) initiatives for both compliant and non-compliant populations.

• Supervise Health Choices/Commercial prenatal-postpartum (PNPP) populations as designated.

• Conduct outreach efforts for assigned HEDIS/PNPP member caseloads.

• Execute retrospective medical record evaluations to gather clinical quality data in accordance with NCQA HEDIS/PNPP standards.

• Collaborate with health plan members and primary care providers across various practice locations.

• Promote adherence to clinical guidelines and coordinate necessary services.

• Contribute to quality enhancement initiatives and Health Plan Quality and Work Plans.

• Engage in education regarding regulatory agency standards.

• Implement strategies to enhance population outcomes and improve quality rates/rankings.

• Review physician progress notes, lab results, radiology/imaging reports, and consultation notes.

• Accurately document medical record data in the Quality database.

• Assess targeted measures and coordinate subsequent care.

• Monitor member compliance reports and take action with non-compliant members.

• Provide education to physicians, provider office staff, members, and site personnel on quality standards and preventive health guidelines.

• Support prenatal/postpartum services, risk assessments, care coordination, health and nutrition education, and preventive screenings.

• Act as a voting member in the member appeals process when necessary.

• Identify opportunities for process improvements and assist management with their execution.

• Report quality issues or potential fraud concerns.

• Refer members to Health and Case Management as appropriate.

⛳️ Requirements

• Minimum of three (3) years of experience as a Licensed Practical Nurse (LPN).

• At least 5 years of overall nursing experience.

• Graduation from a Specialty Training Program in Nursing (Required).

• Valid Licensed Practical Nurse certification/license.

• Knowledge of medical record review processes.

• Understanding of regulatory agency standards.

• Proficient in computer skills.

• Strong critical thinking abilities.

• Excellent organizational skills.

• Availability to work Monday–Friday, from 8:00am to 4:30pm.

• Willingness to travel to assigned provider offices and community outreach events as required.

🏝️ Benefits

• Comprehensive benefits package (health, dental, and vision) starting on day one.

• Selection of three medical plans, including an expanded network for out-of-area employees and their dependents.

• Pre-tax flexible spending accounts (FSA) for healthcare and dependent care.

• Health savings account (HSA).

• Company-sponsored life insurance.

• Coverage for short-term disability.

• Coverage for long-term disability.

• 401(k) plan with automatic contributions from Geisinger.

• Generous paid time off (PTO) policy.

• Up to $5,000 in tuition reimbursement each calendar year.

• MyHealth Rewards wellness program offering financial incentives.

• Adoption and fertility assistance.

• Paid parental leave.

• Paid military leave.

• Complimentary Care.com membership with discounted backup care.

• Employee Assistance Program (EAP).

• Free legal advice.

• Access to mental health visits.

• Work-life balance support.

• Digital self-help resources.

• Optional accident insurance.

• Critical illness insurance.

• Hospital indemnity coverage.

• Identity theft protection services.

• Universal life insurance options.

• Pet insurance availability.

• Legal insurance options.

• Healthcare benefits for both full-time and part-time positions from day one, including vision, dental, and coverage for domestic partners.