LPN- Medicare Advantage Quality Coordinator

LPNME026352

The Medicare Advantage (ISNP) Quality Coordinator supports quality improvement initiatives for Institutional Special Needs Plans (ISNP). This role ensures compliance with CMS quality standards, assists with data collection and reporting, and collaborates with internal teams to improve health outcomes and member experience. The position focuses on monitoring performance metrics, supporting audits, and driving continuous improvement in quality programs.

ESSENTIAL JOB DUTIES:

To perform this job successfully, an individual must accomplish each essential function satisfactorily, with or without reasonable accommodation:

·         Monitor and track ISNP quality performance measures, including HEDIS and Star Ratings.

·         Assist in the development and implementation of quality improvement projects and initiatives.

·         Collect, validate, and analyze data to identify trends and opportunities for improvement.

·         Support compliance with CMS regulations and organizational policies related to ISNP quality programs.

·         Prepare reports and presentations for internal stakeholders and leadership.

·         Collaborate with clinical, operational, and compliance teams to ensure alignment on quality goals.

·         Participate in audits and readiness reviews, providing documentation and responding to inquiries.

·         Maintain accurate records and documentation for quality activities.

·         Other duties as assigned.

REQUIRED QUALIFICATIONS:

• Education:
  • Must be a licensed practical nurse
• Experience:
  • Familiarity with Medicare Advantage, quality improvement, or managed care.
  • Familiarity with CMS regulations, HEDIS measures, and Star Ratings.

REQUIRED KNOWLEDGE / SKILLS:

·         Strong analytical and problem-solving skills.

·         Excellent written and verbal communication skills.

·         Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint).

·         Ability to manage multiple priorities and meet deadlines.

PREFERRED QUALIFICATIONS:

·         Experience with ISNP programs or long-term care settings

·         Knowledge of quality reporting tools and data analysis software; Knowledge of NCQA accreditation preferred

·         Certification in healthcare quality (e.g. CPHQ) is a plus