HEDIS Medical Review Nurse

3 weeks ago

baltimore, United States nTech Workforce Full time

Terms of Employment

  • Contract, 6 Months
  • This is a hybrid position. The resource may occasionally be required to visit provider offices.
  • Candidates located in the Washington D.C., Maryland, Virginia area are preferred.


Overview

Our client is seeking HEDIS Medical Review Nurses to join the Quality Team, where they will conduct thorough HEDIS overreads in accordance with NCQA guidelines. Responsibilities include assisting with Medical Record Retrieval for HEDIS and Risk Adjustment, participating in internal audits for Supplemental Data, and supporting various needs within the Quality Department. Nurses will accurately over-read medical record abstractions completed by the HEDIS team, correcting errors and providing re-education when necessary. They will utilize software applications for data entry and chase status updates while maintaining productivity levels set by the QI Department. Compliance with HIPAA and confidentiality standards is required, along with other duties as assigned.


The client is seeking qualified RN/LPNs with experience in HEDIS reporting and overread processes. The ideal candidates will have a robust understanding of healthcare quality metrics and a proven track record of accurate data abstraction and interpretation. Applicants must be detail-oriented and able to work independently while maintaining a high level of accuracy. Prior experience in HEDIS and overread review is essential for this role.

Required Skills & Experience

  • RN - Registered Nurse - State Licensure And/or Compact State Licensure RN-VA, DC and or MD (must have an active license).
  • 3 years clinical experience, and 5 years HEDIS and Overread experience.
  • In lieu of education, 10 years of recent HEDIS abstractions / overreads experience in the payer/health insurance side of HEDIS or with a HEDIS vendor (ex. Cotiviti, Inovalon, Reveleer) is required.
  • Current knowledge of clinical practices related to HEDIS and Medical Record Review.
  • Robust understanding of healthcare quality metrics.
  • Proven track record of accurate data abstraction and interpretation.
  • Experience in using Microsoft Office (Excel, Word, Power Point, etc.) and web-based technology.
  • Need to be able to work in a time-sensitive and fast paced environment.
  • Ability to effectively communicate and provide positive customer service to every internal and external customer.
  • Strong interpersonal skills.
  • Ability to work independently, as well as a member of a team.
  • Strong organizational skills, ability to prioritize responsibilities with attention to detail.
  • Able to change/shift priorities as needed.

Certification

  • Bachelor's degree in Nursing, Associates Degree in Nursing, Diploma in Nursing.
  • At least two consecutive HEDIS seasons with the same company.

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