LPN – Licensed Practical Nurse, QA Nurse Specialist

Job not on LinkedIn

🔥 3 hours ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔧 QA Engineer (Quality Assurance)

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 10%

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Geisinger

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1915

🏥 Healthcare

💊 Pharmaceuticals

🧘 Wellness

Healthcare • Pharmaceuticals • Wellness

Geisinger is a healthcare organization that has been providing accessible medical services for over a century in Pennsylvania. It focuses on meeting the healthcare needs of its communities and is dedicated to innovative patient care. With career opportunities in various fields including nursing, allied health, and administration, Geisinger promotes professional development and a supportive workplace for its employees, emphasizing diversity, equity, and inclusion.

📋 Description

• Manage annual and proactive HEDIS (PAH) activities for compliant and non-compliant populations • Manage Health Choices/Commercial prenatal-postpartum (PNPP) populations as assigned • Conduct outreach to assigned HEDIS/PNPP member caseloads • Perform retrospective medical record reviews to collect clinical quality data under NCQA HEDIS/PNPP specifications • Collaborate with health plan members and primary care providers across multiple practice sites • Facilitate clinical guideline adherence and coordinate services • Contribute to quality improvement interventions and Health Plan Quality and Work Plans • Participate in regulatory agency standards education • Execute interventions to improve population outcomes and quality rates/rankings • Review physician progress notes, laboratory data, radiology/imaging reports, and consult notes • Document medical record data accurately in the Quality database • Review targeted measures and coordinate follow-up care • Track member compliance reports and intervene with non-compliant members • Educate physicians, provider office staff, members, and site personnel on quality standards and preventive health guidelines • Support prenatal/postpartum services, risk assessment, care coordination, health and nutrition education, and preventive screenings • Participate as a voting member in the member appeals process when needed • Identify process improvement opportunities and assist management with implementation • Report quality or potential fraudulent issues • Refer members to Health and Case Management when appropriate

🎯 Requirements

• At least three (3) years of LPN work experience • Minimum of 5 years of nursing experience • Graduate from Specialty Training Program-Nursing (Required) • Licensed Practical Nurse certification/license • Familiarity with medical record review • Familiarity with regulatory agency standards • Computer literacy • Critical thinking • Organizing • Ability to work Monday–Friday, 8:00am–4:30pm • Travel to assigned provider offices and community outreach events may be required

🏖️ Benefits

• Full benefits (health, dental and vision) starting on day one • Three medical plan choices, including an expanded network for out-of-area employees and dependents • Pre-tax healthcare and dependent care flexible spending accounts (FSA) • Health savings account (HSA) • Company-paid life insurance • Short-term disability coverage • Long-term disability coverage • 401(k) plan with automatic Geisinger contributions • Generous paid time off (PTO) plan • Up to $5,000 in tuition reimbursement per calendar year • MyHealth Rewards wellness program with a financial incentive • Adoption and fertility assistance • Parental leave pay • Military leave pay • Free Care.com membership with discounted backup care • Employee Assistance Program (EAP) • Free legal guidance • Mental health visits • Work-life support • Digital self-help tools • Voluntary accident insurance • Critical illness insurance • Hospital indemnity insurance • Identity theft protection • Universal life insurance • Pet insurance • Legal insurance • Healthcare benefits for full-time and part-time positions from day one, including vision, dental and domestic partners