Case Nurse

4 weeks ago

Pennington, United States Collabera Full time

Description

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Case Nurse

Remote: Pennington, New Jersey, US

Salary: $44.00 Per Hour

Job Code: 352807

End Date: 2024-09-14
Days Left: 28 days, 3 hours left

Apply

About the Role:
  • We are seeking a Quality Auditor to conduct quality audits for state audits, HEDIS, and quality referral and complaints issues.
    The role also involves preparing various reports on a weekly, monthly, quarterly, and year-end basis.
Responsibilities:
  • Conduct on-site/virtual reviews at participating provider offices to assess environment, quality of physicians' medical records, and compliance with HEDIS documentation standards.
  • Attend HEDIS Measure and QMRM training and pass with 100% accuracy.
  • Assist the Quality Management department with special projects and focused clinical studies.
  • Perform related tasks or special studies as requested.
  • Assist in training providers on audit standards off-site.
  • Serve as an in-house representative for chart chase audits.
  • Produce various reports as requested.
  • Review supplemental data charts (approx. 50 charts per day) as assigned by team leads and process them in format.
  • Work with providers to obtain charts for chart chase and review them in a timely manner (24 hours).
Education Qualification:
  • Requires three to five years of related business experience, preferably in the healthcare industry.
  • Requires a License Practical Nurse License or an active New Jersey Registered Nurse License.
Required Skills:
  • Knowledge of managed care principles.
  • Knowledge of medical terminology.
  • Knowledge of PCs and related software.
  • Prefer knowledge of URAC accreditation standards and HEDIS principles.
  • Prefer knowledge of health management or patient education.
  • Excellent verbal and written communication skills.
  • Excellent organization skills.
  • Strong analytical skills.
  • Good problem-solving/conflict resolution skills.
  • Good decision-making skills.
  • Strong PC skills.
  • Strong presentation skills.
Job Requirement
  • HEDIS
  • clinical
  • medical terminology
  • health management
  • Nurse
  • RN
  • LPN
  • Licensed Practical Nurse
  • Registered Nurse
  • Medical records
Reach Out to a Recruiter
  • Recruiter
  • Email
  • Phone
  • Rohan Lazarus
  • rohan.lazarus@collabera.com


Apply Now

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