HEDIS Nurse

Job Description

A Special Project Nurse/Medical Professional will be responsible for completing auditing and/or medical records review projects. Responsibilities includes medical records reviews, data collection, chart abstractions, reporting and analyses. Must have good communication skills to interface with United Health Services personnel and be very detailed oriented. This position is responsible for HEDIS data collection and reports to the Quality Management Manager.

Coordinates and performs onsite medical record reviews medical record collection at provider offices

Supports the HEDIS medical record chase to support optimum HEDIS and quality metric reporting.

Supports quality improvement, requesting records from providers, maintaining databases, and researching to identify members' provider encounter history

Enter documentation of findings in identified database

Qualifications

RN/LPN

5+ years clinical experience, or other relevant experience

2+ years of quality improvement experience, or other relevant experience

MUST HAVE PRIOR HEDIS EXPERIENCE (at least 1-2 season) and be knowledgeable on various HEDIS measures.

Must have strong experience using MS Excel, for data entry

Experience working in Medicaid and/or Medicare health care and insurance industry, including regulatory and compliance requirements

Knowledge base of clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements, and the managed care industry.

Ability to travel to physician offices if required; valid state-specific driver's license and reliable vehicle.

Strong organizational skills and ability to work both independently and with teams.

Ability to evaluate medical records with attention to detail.

Ability to interact with medical staff, peers, and internal company staff at all levels.

Ability to use databases and prepare reports as needed

Proficiency in software applications that include, but are not limited to, Microsoft Word, Microsoft Excel. Outlook

Demonstrated ability to assist with focusing activities toward a strategic direction as well as develop tactical plans, drive performance and achieve targets

Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action

Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others.

Additional Information

All your information will be kept confidential according to EEO guidelines.