Special Projects Nurse - HEDIS - Telecommute

SPECIAL PROJECT NURSE -- HEDIS - TELECOMMUTER

HEDIS Operations combines talented individuals from many areas of quality, including HEDIS, CAHPS and Accreditation. Our goal is extraordinary performance that exceeds the expectations of the constituents, customers and members we serve. In this position, you will work with the HEDIS Operations staff to assist with the 2018 data collection cycle.

Mon-Fri standard business hours. \\Candidates can sit anywhere in US, however, must be able to support CST/Mountain

The purposes of this role include, but are not limited to:

1. Market specific data collection efforts and provider outreach

2. Medical record review for HEDIS and HEDIS-like measures

3. Over-read of medical records The candidate must be technically savvy and must be able to work without distraction. This is a high production environment, and candidates must adhere to measured productivity requirements.

Responsibilities:
Performs provider/practitioner medical record reviews for HEDIS and HEDIS-like measures as part of HEDIS Operations

Reviews assigned medical records in order to verify clinical data elements for HEDIS reporting, e.g., results of laboratory tests, verification of hypertension and the most recent blood pressure reading, prenatal and postpartum care services

Integrates data collected from a variety of electronic and paper sources

Identifies findings supported by documentation guidelines with high level of accuracy

Maintains HIPAA standards and confidentiality of protected health information; reports critical incidents immediately

Communicates identification of pursuit leads for additional medical records, if needed, to other members of the team

Attends conference calls as necessary to provide information relating to clinical reviews and compliance

Successfully completes HEDIS technical specification training and testing

Successfully completes HEDIS software training and uses software correctly

Responsible for meeting daily over read production goal

Required Qualifications:

Minimum 1 year healthcare/health plan experience

Minimum 1 year HEDIS experience and/or knowledge

Solid knowledge of managed care requirements related to clinical quality

Research and detail oriented, excellent proof reading skills

Excellent time management and prioritization skills Strong communication skills

Strong proficiency with Microsoft Office applications, including: Word, Excel, Adobe and PowerPoint

Critical thinking skills Results-driven independent worker and self-starter

Preferred Qualifications:

Clinical degree highly preferred, including, but not limited to: RN, LVN, LPN

Current, unrestricted state license in applicable field

Experience working with HEDIS software (data entry, reporting)

Experience in medical record review (vendor or health plan; onsite or fax/mail)

Experience working in EMR systems

Associated topics: from your home, home based, home based contractor, home office, home office work, part time remote, telecommute, telecommute job, work at home employment, work remote