Kaiser Permanente Coord, Medicaid Outreach Ped LPN FT(40hrs) in Atlanta, Georgia
The Medicaid and CHIP Quality Outreach Coordinator provides support and expertise as a member of the pediatric HEDIS quality team by preforming outreach efforts to Medicaid and CHIP patients to improve clinical gaps. Through data collection from CarePOINT, GRITS, medical record review, and Amerigroup Reporting this role will focus on improving the Medicaid and CHIP Pediatric HEDIS results.
Contribute to the planning, execution, and reporting of Pediatric Medicaid strategic outreach efforts. Identification of patients with care gaps. For Medicaid and Children Health Insurance Program (CHIP) assigned patients to the Outreach Coordinator will identify and analyze patients with clinical care gaps, unestablished relationships with Pediatrician or missed screenings by conducting medical chart reviews, reviewing internal reports, and reviewing Care Management Organization (CMO reports. This function requires reconciling information from multiple sources to identify the appropriate patients for outreach, and to determine what level of outreach is needed. Care gap needs and screening needs are governed by HEDIS standards. Outreach for patients with care gaps and missed screens. Outreach coordinator will contact the parent or guardian of assigned patients who were identified as having clinical care gaps or missed screenings to meet HEDIS requirements. Contact is primarily by telephone or secondarily by letter. Contact is to remind the parent or guardian of the care gap or needed screening, and to make appointments for the pediatric patients. The choice of which patient is contacted is based on strategic goals and workflows.
Support patients with navigation of care by acting as a reliable advocate. Assist patients with care coordination within scope of practice guidelines. Work closely with healthcare teams to ensure plan of care is followed. Enter all appropriate data in the Georgia Registry of Immunization Transactions and Services (GRITS) and EMR. Coordinate and participate in medical office and community outreach events. Participate in departmental meetings, staff trainings, and other quality improvement initiatives. Meet timeframes for performance while balancing the need to produce high quality work related to complex and sensitive member issues. Demonstrate effective knowledge of various tools and systems (e.g. KPHC, Excel, KPGA Report Portal, Tableau, CMO Provider Portals) to access patient data, send orders for provider, document member touches and communicate with HealthCare teams.
Generate monthly outreach report based on outreach efforts and outcomes. May provide intermittent support to and other entities within the Department of Pediatrics, Community Benefit, and/or Market Strategy. May be responsible for other initiatives as assigned.
Participates in monthly well child HEDIS meetings.
Minimum three (3) years of working with Medicaid or low income populations.
Minimum three (3) years of pediatric outpatient clinical nursing experience as LPN.
- High School Diploma OR General Education Diploma (GED) required.
License, Certification, Registration
Knowledge of registries and experience with data collection and analysis.
Knowledge of CarePoint, Excel and GRITS registry.
Knowledge of HEDIS specifications and methodology.
Experience in electronic medical record documentation.
Experience with care management programs for chronic conditions.
Fluency in Spanish.
- Bachelor's degree in business administration, communication, marketing, or health related field.
TITLE: Coord, Medicaid Outreach Ped LPN FT(40hrs)
LOCATION: Atlanta, Georgia
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.