Quality Assurance Nurse Reviewer (Overread Team) - (100% REMOTE)

Spectraforce Technologies; United States; Remote; USD 60,000 - 90,000; Full time

Job summary

An established industry player seeks a Quality Assurance Nurse Reviewer to join their remote Overread Team. In this pivotal role, you will be responsible for conducting thorough quality assurance reviews of medical records, ensuring compliance with HEDIS standards. Your expertise will help validate data, support quality improvement initiatives, and maintain high productivity and accuracy. This position offers a dynamic work environment where your attention to detail and strong communication skills will shine. Join a forward-thinking company that values diversity and provides comprehensive benefits, including health, dental, and a 401K plan with matching. If you're ready to make a significant impact in healthcare quality assurance, this opportunity is for you.

Benefits

Health Insurance

Dental Insurance

Vision Insurance

401K Plan with Matching

Commuter Benefits

Referral Bonus Program

Qualifications

• Must have RN or LPN/LVN license with 3-5 years of HEDIS experience.
• Strong computer skills and ability to work independently are essential.

Responsibilities

• Perform quality assurance reviews on medical records under HEDIS guidelines.
• Validate and enter findings electronically into a specified database.

Skills

Quality Assurance

Medical Record Review

Data Entry

Communication Skills

Time Management

Attention to Detail

Computer Skills

Flexibility

Education

RN or LPN/LVN License

3-5 Years HEDIS Experience

Tools

Microsoft Office Suite

Job description

Quality Assurance Nurse Reviewer (Overread Team) - (100% REMOTE)

Job Description

Job Title: Quality Assurance Nurse Reviewer (Overread Team) -(100% REMOTE)
Actual Job Title: Quality Clinical Management Senior Analyst - HEDIS
Duration: 4 Months
Schedule: 8:00 AM to 5:00 PM
Note: Must have a reliable internet connection and experience working in a remote setting.

Job Responsibilities:

• The Healthcare Effectiveness Data and information Set (HEDIS) Quality Assurance Nurse Overreader works under the direction of the HEDIS Quality Assurance Team Lead and other Company personnel to perform quality assurance reviews on medical records.
• The HEDIS Quality Assurance Nurse Reviewer will validate abstracted medical record data and enter findings electronically into a specified database to support HEDIS Reporting and Quality Improvement.
• The candidate may be required to perform other duties toward HEDIS collection as assigned including HEDIS medical record review and outreach for collection of medical records.
• This is a fast-paced environment, and candidates must adhere to measured productivity and accuracy requirements.
• The candidate is required to attain a score of 100% on specific measure testing prior to conducting live medical record reviews and overreads.
• Candidate must also be able to achieve and maintain a quality reliability score of 95% or higher to remain eligible for employment for the duration of the project.

Required Skills:

• Follow established procedures for conducting Quality Assurance Overread reviews of abstracted medical records
• Extract electronic medical record data using multiple systems
• Enter pertinent data from paper and electronic medical records into database as required by established quality assurance abstraction procedures
• Communicates effectively and professionally
• Meet or exceed productivity and accuracy requirements
• Ability to work independently and in team environment
• Excellent time management and prioritization skills
• Excellent communication skills (written and verbal)
• Strong attention to detail
• Ability to multi-task
• Flexibility with assignment change
• Highly organized
• Evidence of strong computer skills including the Microsoft office suite (e.g., Microsoft Outlook, Excel, and Word)
• Maintain patient confidentiality by protecting patient information from unauthorized disclosure
• Other duties as assigned

Education/Experience:

• RN or LPN/LVN license.
• 3-5 years recent HEDIS medical record review experience preferred
• Quality improvement or medical record review experience preferred
• Computer experience (i.e., Excel, Word, Outlook) required

About Us:Established in 2004, SPECTRAFORCE is one of the largest and fastest-growing diversity-owned staffing firms in the US. We provide talent and project-based solutions, including Contingent, Permanent, and Statement of Work (SOW) services to over 140 clients in various industries. Learn more at: http://www.spectraforce.com

Benefits: SPECTRAFORCE offers ACA compliant health benefits as well as dental, vision, accident, critical illness, voluntary life, and hospital indemnity insurances to eligible employees. Additional benefits include commuter benefits, 401K plan with matching, and a referral bonus program.

Equal Opportunity Employer:SPECTRAFORCE is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, age, sexual orientation, gender identity, genetic information, disability or veteran status, or any other category protected by applicable federal, state, or local laws.