The CKHobbie Group

Role Description This is a remote position. Seeking a detail-oriented and highly analytical Registered Nurse (RN) to join our team in a HEDIS Abstraction role, supporting critical healthcare quality initiatives across Pennsylvania. While the home office is based in Harrisburg, this position is fully virtual and open to candidates located anywhere within the state. This role offers a unique opportunity for experienced RNs who are looking to step away from bedside care and apply their clinical expertise in a focused, data-driven environment that directly influences patient outcomes and healthcare performance. - Review and abstract clinical data from medical records in accordance with HEDIS measures. - Analyze documentation related to preventive care, chronic disease management, and behavioral health services. - Ensure all information is accurately captured and compliant with NCQA guidelines and measure specifications. - Utilize abstraction tools and electronic medical record systems to document findings. - Maintain audit readiness and ensure a high level of accuracy. - Consistently meet deadlines during peak reporting periods. - Impact healthcare quality scores, reimbursement, and public reporting. - Collaborate with healthcare providers, health plans, and internal quality teams to resolve discrepancies. - Manage workflow in a structured remote environment while maintaining performance expectations. This position is ideal for Registered Nurses seeking greater flexibility, a predictable schedule, and the opportunity to leverage their clinical knowledge in a non-patient-facing role. It provides exposure to healthcare quality improvement, compliance, and population health, helping you build specialized skills that are highly valued across the healthcare industry. Qualifications - Active RN license. - Strong understanding of medical terminology and clinical documentation. - Familiarity with coding systems such as ICD-10 and CPT (highly preferred). - Experience with electronic medical records. - Detail-driven and organized. - Comfortable working independently in a fully remote environment. Requirements - Ability to maintain high standards of accuracy and productivity.

Role Description As a key member of our care team, you will engage with members in person—either at a facility or in a community setting—as well as virtually over the phone. You will support members by assessing their overall health and wellness, helping them set meaningful goals, and guiding them toward healthier lifestyles through personalized, compassionate care. - Establish meaningful connections with members through face-to-face or telephonic interactions. - Conduct comprehensive assessments that address members' biopsychosocial, functional, and behavioral health needs. - Apply motivational interviewing techniques to help members uncover intrinsic goals and inspire positive behavior change. - Practice active listening to gather relevant information and respond dynamically during assessments. - Encourage active participation in the assessment process and collaboratively develop individualized plans of care that reflect each member’s goals, needs, and preferences. - Identify urgent or high-risk situations and escalate appropriately to ensure timely intervention. - Partner with members to define health goals and identify barriers that may impact goal achievement. - Provide education on health and wellness topics to support self-management and improved outcomes. - Work collaboratively with members to develop practical solutions to overcome barriers to care. - Identify and connect members to appropriate community resources based on identified needs. - Present complex case details to the interdisciplinary care team and integrate their input into care plans as needed. - Utilize computer applications (e.g., Microsoft Excel, Word, Outlook, Office Communicator) to document and share member-related information. - Accurately and promptly document assessments, interactions, referrals, and follow-up plans in relevant systems. - Stay current with updates and changes to computer systems and effectively apply knowledge in day-to-day work. - Meet or exceed performance metrics within a virtual, productivity-driven environment. Qualifications - Deep passion and commitment to supporting individuals with complex medical, behavioral, or social needs. - Bachelor’s degree in Social Work, or license as a Licensed Practical Nurse (LPN), Certified Nursing Assistant (CNA), or Home Health Aide (HHA) preferred. - Alternatively, a high school diploma or equivalent with a minimum of 3 years of experience in a community health or healthcare setting, or demonstrated experience using motivational interviewing techniques. - Must be fully vaccinated against COVID-19. - Proficiency with Microsoft Office products, particularly Word and Outlook; ability to quickly learn and navigate clinical or member-related applications. - A dedicated, private home workspace with secure, high-speed internet access via cable or DSL. - Valid driver’s license, active auto insurance, and reliable transportation for occasional field visits to members, hospitals, or community locations. - Residency within the Philadelphia, PA area is required. Preferred Qualifications - Bilingual proficiency (spoken and written). - Formal training or demonstrated skill in motivational interviewing.

• Make a difference where it truly matters—supporting some of Pennsylvania’s most vulnerable residents living in long-term care and licensed settings across the Commonwealth. • As a Workload Manager, you’ll play a vital behind-the-scenes role in protecting health, safety, and dignity by ensuring concerns are taken seriously, investigated thoroughly, and resolved effectively. • This position offers the rare reward of blending purpose-driven public service with analytical, investigative, and leadership responsibilities. • Every complaint reviewed, system improved, and report generated directly contributes to safer environments and stronger accountability for providers serving older adults and individuals in care. • In this role, you’ll collaborate with licensing staff, law enforcement, and state partners to manage complaint and incident tracking systems, prioritize investigations, coordinate inspections, and support enforcement actions when needed. • You’ll use data, research, and policy analysis to strengthen programs, guide staff, and improve statewide systems—turning information into action that protects people.

• Conducts program and information system analysis on a statewide basis. • Assists in implementation of enforcement orders, such as emergency closure orders and prohibition of access orders. • Schedules and coordinates all licensed setting inspections for the region. • Conducts meetings with licensing staff for scheduling and other matters. • Oversees the regional fines management system, reviewing, and evaluating corrective action plans and monitors the implementation. • Conducts onsite inspections for verifying corrective action plans. • Coordinates referrals and criminal investigations with law enforcement agencies, including state and local police and Office of the Attorney General. • Reviews content of incident reports and complaints. • Follows-up with providers and complainants as needed for additional information. • Assesses and assigns priority levels for complaints and incident reports received. • Assigns complaint/incident inspections to the Licensing Representatives/Technicians for further investigation. • Files incident reports and other licensing documents or scans such documents to electronic records. • Designs and conducts research studies relating to licensed settings. • Assists in data entry and data analysis relating to licensed settings. • Takes complaints and enters them into the complaint tracking system. • Enters incident reports into incident tracking system. • Generates weekly and monthly reports and ad hoc reports using data collection methods and tools; prepares tables and graphs from analysis for inclusion in Departmental statistical reports. • Ensure data integrity through regular monitoring of database systems. • Organizes and analyzes data which may involve reviewing regulator information or applying statistical methods to analyze data in order to draw conclusions, make recommendations, and suggest system improvements and program alternatives. • Reviews, analyzes, and recommends revisions to existing and proposed policies, regulations, and procedures. • Coordinates the maintenance of information technology applications to support program operations. • Responds to inquiries from providers, other state and local agency officials, consumers, Department licensing staff, and Department program offices. • Oversees the usage of equipment for the region; coordinates all necessary equipment needed to conduct presentations and training provided in the regional office. • Provides guidance and direction to licensing representatives/technicians in the regional office regarding complaint and incident information and their respective tracking systems.

• Conduct thorough and systematic audits of healthcare facilities and service providers to assess compliance with regulations and standards related to community health, mental health, and drug addiction services. • Leverage a deep understanding of mental health and drug addiction counseling to evaluate the quality and effectiveness of treatment programs, patient care, and prevention efforts in the community. • Conduct investigations into allegations of misconduct, fraud, or violations within community health programs. Gather evidence, interview witnesses, and compile detailed reports for further action. • Analyze healthcare data, patient records, and service outcomes to identify trends, disparities, and potential areas for improvement in community health services. Utilize this analysis to make data-driven recommendations. • Stay up-to-date with federal and state healthcare regulations, policies, and guidelines. Ensure that healthcare facilities and programs within the community adhere to all relevant laws and regulations. • Prepare detailed reports summarizing audit findings, investigations, and compliance assessments. Communicate findings to relevant stakeholders, including government agencies, healthcare providers, and community organizations. • Collaborate with a multidisciplinary team of healthcare professionals, auditors, and regulatory authorities to address compliance issues, improve services, and facilitate positive changes within the community. • Engage with community members, advocacy groups, and healthcare stakeholders to gather insights, identify challenges, and address the unique needs of the community.