| JOB TITLE:Quality Improvement Nurse Specialist LPN LOCATION: 58-60 Public Square Wilkes Barre DEPARTMENT:Quality and Accreditation WORK SCHEDULE: Days WORK TYPE: Full time JOB SUMMARY: Responsible for managing annual & proactive HEDIS (PAH) for compliant/ non-compliant population, Health Choices/Commercial prenatal-postpartum (PNPP) population as assigned. Responsible for and evaluated against success with outreach to assigned HEDIS/PNPP member case load. Responsible for retrospective medical record review to obtain clinical quality data per the HEDIS/PNPP specifications set forth by the National Committee for Quality Assurance (NCQA). Collaborates with GHP members and primary care providers in multiple practice sites to facilitate clinical guideline adherence and coordinates services as needed. Contributes to the design and implementation of interventions developed by quality improvement workgroups to achieve the goals and objectives defined within the Health Plan's Quality Plan and Work plan. Reports directly to the Manager, Quality Strategies. COMPETENCIES AND SKILLS: Demonstrates leadership qualities including time management, problem solving, decision-making, and excellent verbal/written communication skills. Demonstrates ability to interact effectively and collaboratively with providers, members, and internal Health plan staff. Demonstrates excellent organizational skills, is flexible and able to establish priorities daily, and can function with a high degree of independence with attention to detail. Demonstrates a general concept of managed care, in addition to, excellent knowledge of medical terminology and ability to review medical records. Demonstrated ability to educate small groups. Demonstrates basic database knowledge, keyboarding skills. Demonstrates strict adherence to confidentiality standards. EDUCATION AND/OR EXPERIENCE: Current LPN licensure in the state of Pennsylvania required. Minimum five years’ experience in a clinical setting or a quality related field required. Clinical experience with all ages in an outpatient setting preferred. Ambulatory/managed care experience preferred. Previous chart review/audit experience preferred. Basic understanding of coding preferred. WORKING CONDITIONS/PHYSICAL DEMANDS: Work is typically performed in a clinical/office environment. Independent travel involved in job duties. Valid Pennsylvania driver's license and access to personal transportation for traveling purposes required. The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job. OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. GEISINGER HEALTH PLAN (GHP) is the health insurance component of Geisinger and serves over 460,000 members in Pennsylvania and West Virginia. Begun in 1985, GHP provides high quality, affordable health-care benefits for businesses of all sizes, individuals and families, and Medicare beneficiaries. About Geisinger: Geisinger is a physician-led health system comprised of approximately 30,000 employees, including nearly 1,600 employed physicians, 13 hospital campuses, two research centers, and a 583,000-member health plan Geisinger is nationally recognized for innovative practices and quality care. Geisinger serves more than 3 million people in central, south-central and northeast Pennsylvania and also in southern New Jersey with the addition of National Malcolm Baldridge Award recipient AtlantiCare, A member of Geisinger. In 2017, the Geisinger Commonwealth School of Medicine became the newest member of the Geisinger Family. We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners.* Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. For more information, visit www.geisinger.org, or connect with us on Facebook, Instagram, LinkedIn and Twitter. ** Does not qualify for J-1 waiver. We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status. *Domestic partner benefits not applicable at Geisinger Holy Spirit. | 
