HEDIS NURSE

Integrated Resources Inc.; New York (NY); On-site; USD 70,000 - 100,000; Full time

Job summary

A leading company seeks a Special Project Nurse/Medical Professional responsible for auditing and reviewing medical records to support quality improvement and HEDIS data collection. The ideal candidate will have RN/LPN credentials with extensive clinical and HEDIS experience. Strong organizational skills and proficiency in Microsoft Excel are essential for this role, which may involve travel to physician offices.

Qualifications

• 5+ years clinical experience or relevant experience.
• 2+ years of quality improvement experience.
• Prior HEDIS experience (1-2 seasons) required.

Responsibilities

• Conduct medical record reviews and data collection.
• Support HEDIS quality metric reporting.
• Enter documentation of findings in database.

Skills

Communication

Attention to detail

Problem solving

Organizational skills

Education

RN/LPN

Tools

Microsoft Excel

Microsoft Word

Microsoft Outlook

Job description

Integrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively. Since launching in 1996, IRI has attracted, assembled and retained key employees who are experts in their fields. This has helped us expand into new sectors and steadily grow.

We’ve stayed true to our focus of finding qualified and experienced professionals in our specialty areas. Our partner-employers know that they can rely on us to find the right match between their needs and the abilities of our top-tier candidates. By continually exceeding their expectations, we have built successful ongoing partnerships that help us stay true to our commitments of performance and integrity.

Our team works hard to deliver a tailored approach for each and every client, critical in matching the right employers with the right candidates. We forge partnerships that are meant for the long term and align skills and cultures. At IRI, we know that our success is directly tied to our clients’ success.

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.