Provides care under the direct supervision of the Nursing Supervisor of Quality Improvement, utilizing physician approved patient protocols according to established standards and best practice guidelines.Facilitates the communication between patient/caregiver, physician and the outpatient care team to optimize health and wellness, reduce inpatient admission, reduce re-admissions and improve medical stability in the patient population served. Responsible for the coordination of HEDIS data gathering process by evaluating the quality and completeness of clinical documentation processes. Performs quality medical record reviews, assisting providers and staff in the improvement of clinical documentation process, identifying trends and gaps in care, maintaining accurate records of review activities, ensures all data submitted to the health plan meets the HEDIS technical specifications for medical records. Participates in the development and ongoing implementation of quality improvement activities by providing regular and ongoing physician/staff support and education.
Manages a caseload of 5,000-10,000 patients with identified gaps in care, in collaboration with the Health Care Team.
Request records from provider's offices as needed and perform a review of medical records for data collection, data entry, and quality monitoring including health plan and chart collection activities that close gaps in care.
Observe and Identify trends and potential strategies by collaborating with the leadership team, the provider administrative or clinical staff.
Track and trend barriers / challenges that exist to achieve better outcomes, including access to appointments, lack of follow up, or documentation.
Communicate scheduling challenges or trends that may negatively affect quality outcomes.
Activities may include data collection, data entry, quality monitoring, health plan and chart collection activities.
Navigate multiple EMR systems and obtain medical record sections supportive of HEDIS measures.
Maintains education / knowledge base of HEDIS / STARs.
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.