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Quality Assurance Nurse

2 months ago

Pennington, Alabama, United States Collabera Full time

Position Overview:

We are looking for a dedicated Quality Auditor to perform comprehensive quality assessments for state audits, HEDIS, and quality-related referral and complaint matters.

This position also entails generating various reports on a weekly, monthly, quarterly, and annual basis.

Key Responsibilities:

Conduct both on-site and virtual evaluations at affiliated provider locations to examine the environment, assess the quality of medical records maintained by physicians, and ensure adherence to HEDIS documentation standards.

Participate in HEDIS Measure and QMRM training sessions and achieve a 100% accuracy rate.
Support the Quality Management division with special initiatives and targeted clinical research.
Execute related tasks or special projects as assigned.
Provide training to providers regarding audit standards off-site.
Act as an internal representative for chart chase audits.
Generate various reports as needed.
Review supplemental data charts (approximately 50 charts daily) as designated by team leaders and process them accordingly.
Collaborate with providers to acquire charts for chart chase and review them promptly (within 24 hours).

Educational Requirements:
A minimum of three to five years of relevant business experience, ideally within the healthcare sector.
A valid License Practical Nurse License or an active New Jersey Registered Nurse License is required.

Essential Skills:
Proficient understanding of managed care principles.
Familiarity with medical terminology.
Competence in using PCs and related software.
Preferably knowledgeable about URAC accreditation standards and HEDIS principles.
Preferably experienced in health management or patient education.
Excellent verbal and written communication abilities.
Strong organizational skills.
Solid analytical capabilities.
Effective problem-solving and conflict resolution skills.
Good decision-making aptitude.
Proficient PC skills.
Strong presentation abilities.