LVN Case Manager, CCM

Engages physicians and office staff to facilitate discussions on HEDIS Part C Part D measures. Performs medical record reviews, abstraction and data-entry for HEDIS as part of HEDIS operations to close GAPs in care. Prepares reports and presentations outlining progress findings, and recommendations for management or regulatory bodies.

Conducts monthly reviews in a timely manner and in accordance with established guidelines. Tracks compliance issues, trend data, prepares regular reporting to enhance performance related to HEDIS measures, and distributes to providers and internal teams. Stays informed about the HEDIS/STAR rating requirements and applicable annual updates.

Prepares, submits, and bill findings to external stakeholders, ensuring adherence to reporting deadlines. Presents a summary of all tracking reports to identify areas of improvement monthly or upon request. Road travel required - 25% (Victor Valley surrounding cities) Performs other related duties as assigned. The pay range for this position at commencement of employment is expected to be between $27.

66 and $29.07/hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, skills, and experience. The total compensation package for this position may also include other elements, including a sign-on bonus, restricted stock units, and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

Education

High School graduate Licensure: Graduate from an accredited school for Vocational Nurses. Licensure: Current California LVN license. Experience: One year experience with HEDIS/STAR, medical records review. Knowledge: Required computer applications Excel, Word, Outlook, Power Point. Able to work in a multi-task, high demand environment.

Driving: Driver’s License and proof of Auto Insurance. Position is onsite.