An Exciting and Rewarding Opportunity is Available!
Community First Health Plans -- 110,000 members and still growing. Community First Health Plans, the regions only locally-owned and operated, not-for-profit HMO, was established in 1995, by University Health System, specifically to begin providing health care coverage to the citizens of Bexar and the surrounding seven counties. Our commitment to our members is to provide exceptional health care benefits backed by outstanding service, delivered by people who live right here in South Texas.In our ten years of existence, we have made great strides in becoming a fully mature health plan with a strong balance between our commercial and government-sponsored programs. Our 110,000+ members are divided almost equally among Commercial, Medicaid and Children´s Health Insurance Program (CHIP).Quality Assurance- LVNPosition SummaryThe Quality Assurance- LVN will analyze medical records and other data sources for adherence to standards of care. Conducts focused reviews. Facilitates clinical process improvement activities across CFHP departments. Qualifications RequiredGraduation from an accredited college or university in nursing (LVN) is required, as well as a current nursing license in the state of Texas. A minimum of five years of progressively responsible experience is required. Experience in a managed care organization is also required. Previous HEDIS experience preferred. Knowledge of CQI principles and standard coding products (ICD-9; CPT; HCPCS; DRG) is preferred.