HEDIS Review Nurse - Remote - Contract

HireOps Staffing; United States; À distance; USD 55 000 - 61 000; Plein temps

Résumé du poste

HireOps Staffing is seeking a Review Nurse for a fast-paced contract assignment starting immediately and ending April 30, 2024. The role focuses on medical record abstractions and overreads during the HEDIS survey, following NCQA guidelines and specifications.

Responsibilities include abstracting records, applying criteria, maintaining productivity and 95% accuracy, performing quality reviews, and ensuring HIPAA compliance.

Qualifications

• RN or LPN with unrestricted license and current credentials.
• 2 years HEDIS abstraction/over-reading experience.
• Proficient data entry and basic software skills.
• Excellent written and verbal communication abilities.
• HIPAA and patient confidentiality familiarity.

Responsabilités

• Abstract medical records for HEDIS review.
• Apply product/plan specific abstraction criteria during review.
• Maintain defined productivity volumes.
• Sustain accuracy rate of 95% during abstraction and data entry.
• Perform quality reviews of abstracted records.
• Communicate clearly with management/designee; escalate issues as needed.

Connaissances

HEDIS abstraction

Communication skills

Data entry

Documentation

Formation

RN/LPN license

Outils

PDF

Word

Excel

Description du poste

Review Nurse

This is a contract assignment that will start right away and end on April 30th 2024.

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

Salary: $42/hour