RN LPN Nurse

The ideal candidate is experienced in patient outreach, care coordination, population health, social services, health coaching, or quality improvement and possesses a strong understanding of outpatient healthcare operations and HEDIS-related activities.

Key Responsibilities

·Serve as a trusted advocate and liaison between members, families, healthcare providers, and community resources.

·Conduct telephonic and face-to-face outreach to engage members and address identified care gaps.

·Schedule preventive care appointments and coordinate follow-up services to improve healthcare compliance.

·Educate members and families regarding preventive healthcare, treatment plans, and available community resources.

·Partner with provider offices and clinical teams to improve quality metrics and patient outcomes.

·Support HEDIS and NCQA quality initiatives through member engagement, chart review support, and provider collaboration.

·Assess provider performance data and identify opportunities for quality improvement.

·Collaborate with Provider Relations, Care Management, Quality, Customer Service, and Operations teams to resolve member issues and improve service delivery.

·Arrange transportation and other support services to ensure member access to care.

·Maintain accurate and timely documentation of all member interactions and outreach efforts.

·Refer members to Case Management, Disease Management, Behavioral Health, or other appropriate programs as needed.

·Participate in special projects and departmental initiatives supporting organizational objectives.

·Adhere to all Centene, MHS, regulatory, and compliance standards.

Day-to-Day Activities

·Work onsite within assigned FQHC/provider locations.

·Conduct member outreach and schedule appointments to close gaps in care.

·Meet with members and families to discuss barriers to healthcare access.

·Collaborate with clinic staff to improve quality performance measures.

·Track outreach activities and document interactions within required systems.

·Participate in weekly team meetings and quality improvement discussions.

·Travel locally between assigned clinics as needed.

Required Qualifications

Education

·Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Social Work, Health Administration, or a related field; OR

·Equivalent combination of education and experience totaling at least four years.