HEDIS Review Nurse Specialist

2 days ago


Raleigh, North Carolina, United States Spectraforce Technologies Full time
Job Title: HEDIS Review Nurse

Job Summary:

The HEDIS Review Nurse will be responsible for medical record abstractions and overreads during the annual Healthcare Effectiveness Data and Information Set (HEDIS) survey. The successful candidate will review and accurately perform comprehensive review of medical records to abstract relevant clinical data during HEDIS, in accordance with NCQA guidelines and technical specifications.

Key Responsibilities:

  • Abstract medical records to extract relevant clinical data
  • Apply product/plan specific abstraction criteria/requirements during medical record review process
  • Maintain defined productivity volumes and sustain accuracy rate of 95% during abstraction and data entry throughout the HEDIS survey
  • Perform quality reviews of abstracted medical records as assigned
  • Ensure open and honest communication with management/designee regarding development or assistance needed throughout project
  • Escalate work-related challenges/issues to Senior Director or designee
  • Attend scheduled daily and ad-hoc meetings with HEDIS Project Manager, and/or Quality Management Specialist/designee to discuss project status, open issues, and productivity

Requirements:

  • Registered Nurse (RN)/Licensed Practical Nurse (LPN) with unrestricted license
  • 2 years' HEDIS abstraction/over-reading experience
  • Data entry proficiency
  • Working knowledge of PDF, Word, and Excel
  • Excellent written and communication skills
  • Database management

Preferred Skills:

  • Experience in Pediatrics, Cardiology, Endocrinology, and/or Obstetrics
  • QSHR proficiency


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