Medical, Clinical & VeterinaryClinical Support & Patient Administration
About the job
Requirements
Hold an unrestricted Registered Nurse (RN) or Licensed Practical Nurse (LPN) license.
Have 2 years of HEDIS abstraction or over-reading experience.
Demonstrate data-entry proficiency.
Have working knowledge of PDF, Word, and Excel.
Have database-management skills.
Have written and communication skills.
Responsibilities
Abstract medical records.
Apply product- or plan-specific abstraction criteria and requirements during medical-record review.
Maintain defined productivity volumes.
Sustain a 95% accuracy rate during abstraction and data entry throughout the HEDIS survey.
Perform quality reviews of abstracted medical records as assigned.
Communicate with management or the designee regarding development or assistance needed throughout the project.
Escalate work-related challenges and issues to the Senior Director or designee.
Attend scheduled daily and ad hoc meetings with the HEDIS Project Manager and/or Quality Management Specialist or designee to discuss project status, open issues, and productivity.
Comply with HIPAA, PHI, patient confidentiality, Diversity Principles, Corporate Integrity, Compliance Program policies, and other applicable corporate and departmental policies.
Perform other duties as assigned.
Desired Qualifications
Experience in pediatrics, cardiology, endocrinology, and/or obstetrics.
QSHR proficiency.
This is a contract assignment that will start right away and end on April 30th 2024
Review Nurse
SUMMARY DESCRIPTION:
The review nurse is responsible for medical record abstractions and overreads during the annual Healthcare Effectiveness Data and Information Set (HEDIS) survey. The review nurse is responsible for reviewing and accurately performing comprehensive review of medical records to abstract relevant clinical data during HEDIS. HEDIS abstractions are completed in accordance with NCQA guidelines and technical specifications. Additional responsibilities include but not limited to folder and file management, annotating medical records and saving completed documents with correct naming conventions on a shared drive as well as data entry into QSHR.
ESSENTIAL FUNCTIONS:
Abstract medical records
Apply product/plan specific abstraction criteria/requirements during medical record review process
Maintain defined productivity volumes
Sustain accuracy rate of 95% during abstraction and data entry throughout the HEDIS survey
Perform quality reviews of abstracted medical records as assigned
Ensure open and honest communication with management/designee regarding development or assistance needed throughout project
Escalate work related challenges/issues to Senior Director or designee
Attend scheduled daily and ad-hoc meetings with HEDIS Project Manager, and /or Quality Management Specialist/ designee to discuss project status, open issues and productivity
Comply with HIPAA, PHI, patient confidentiality, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies
Other duties as assigned
JOB REQUIREMENTS:
Registered Nurse (RN)/ Licensed Practical Nurse(LPN) with unrestricted license