HEDIS Nurses

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Job Opportunity: RNs and LPNs for NCQA Audit (HEDIS) Project

Our client, a leading health insurance organization in Southeastern PA, is seeking to hire multiple Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) for their annual NCQA Audit (HEDIS) project. This opportunity offers both fully remote and partially remote roles, with flexible schedules and paid training.

Positions Available:

• Field Data Collection Nurses (Partially Remote)
• Overreaders (Fully Remote)

Field Data Collection (FDC) Nurses (Partially Remote) As an FDC Nurse, you will conduct both remote and onsite medical record reviews. You'll be responsible for scheduling provider office visits, abstracting and entering medical records, and working closely with clinical leads to ensure accurate data collection.

• Flexibility to travel for onsite medical record reviews (as needed).
• Reliable transportation, valid driver's license, and auto insurance required.
• Professional business attire required for in-person visits.

Overreaders (Fully Remote) Overreaders are responsible for performing quality checks of medical record abstractions completed by FDC Nurses. Previous HEDIS experience is required for this position.

• Can be based in any state with a valid nursing license (no compact license needed).
• Fully remote role.

Project Details:

• Start Date: 1/6/2025
• End Date: 4/26/2024

Requirements for Both Roles:

• Reliable internet access and basic proficiency with laptops, smartphones, MS Excel, Outlook, Teams, and Adobe.
• Availability for 8 hours per day during regular business hours (Eastern Time), with some schedule flexibility.
• Experience in chart auditing, abstraction, utilization review, or quality and medical record auditing.

Responsibilities:

• Complete remote training for the first two weeks, including HEDIS measure training, proficiency testing, and company orientation.
• Schedule and attend provider office visits for onsite medical record reviews (travel costs reimbursed).
• Manage your own schedule, balancing remote work and onsite visits.
• Professionally communicate with healthcare facilities, office managers, and care providers.
• Scan, upload, and download medical records daily from onsite reviews.
• Abstract and enter data into the database from remote and onsite visits.
• Review and address any corrections in daily overreads.
• Adhere to all HIPAA, patient confidentiality, and code of conduct requirements.

Equipment Provided:

• Laptop, mobile phone, scanner, encrypted flash drives, and a monitor (for Overreaders). Equipment must be returned at the end of the project.

Team/Territories:

• PA North: Montgomery, Bucks, and some Lehigh counties.
• PA Central: Greater Philadelphia area.
• PA South: Delaware and Chester counties, and Northern Delaware.
• NJ North: Sussex, Passaic, Bergen, Warren, Morris, Essex, Union, and Hudson counties.
• NJ Central: Hunterdon, Somerset, Mercer, Middlesex, Monmouth, and Ocean counties.
• NJ South: Burlington, Camden, Gloucester, Salem, Cumberland, Cape May, and Atlantic counties.

Join a dynamic team and play a crucial role in supporting this important project Apply now to become part of a leading health insurance organization's annual NCQA audit.

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