HEDIS Review Nurse - Remote - Contract

HireOps Staffing, LLC; Dallas (TX); Remote; USD 80,000 - 100,000; Full time

Job summary

A healthcare staffing agency is seeking a Review Nurse for a contract assignment starting immediately. The role involves medical record abstractions and overreads during the HEDIS survey, requiring a Registered Nurse or Licensed Practical Nurse with experience in HEDIS abstraction. Candidates must demonstrate proficiency in data entry and excellent communication skills. The position starts now and ends on April 30, 2024.

Qualifications

• 2 years’ experience in HEDIS abstraction/over-reading.
• Ability to maintain high productivity and accuracy rates.

Responsibilities

• Abstract medical records according to set criteria.
• Perform quality reviews of abstracted medical records.
• Comply with HIPAA and patient confidentiality.

Skills

HEDIS abstraction

Data entry proficiency

Excellent written communication

Education

Registered Nurse (RN)/Licensed Practical Nurse (LPN) with unrestricted license

Tools

PDF

Word

Excel

Job description

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
• 2 years’ HEDIS abstraction/over-reading experience
• Data entry proficiency
• Working knowledge PDF, Word and Excel
• Excellent written and communication skills
• Database management

Preferred Skills

• Experience in Pediatrics, Cardiology, Endocrinology and/or Obstetrics
• QSHR proficiency