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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 evaluations, HEDIS measures, and quality-related referral and complaint matters.

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

Key Responsibilities:

Conduct both on-site and virtual evaluations at participating healthcare provider locations to examine the environment, the quality of medical records maintained by physicians, and adherence to HEDIS documentation criteria.

Participate in HEDIS Measure and QMRM training sessions, achieving a passing score of 100%.
Support the Quality Management department with specialized projects and targeted clinical research.
Execute related tasks or special studies as needed.
Provide training to providers on audit standards remotely.
Act as an internal representative for chart chase audits.
Generate various reports as requested.
Review supplemental data charts (approximately 50 charts daily) as assigned by team leads 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.
Must possess a Licensed Practical Nurse License or an active Registered Nurse License in New Jersey.

Essential Skills:
Familiarity with managed care principles.
Understanding of medical terminology.
Proficiency in PCs and related software applications.
Preferred knowledge of URAC accreditation standards and HEDIS principles.
Preferred experience in health management or patient education.
Exceptional verbal and written communication abilities.
Strong organizational skills.
Excellent analytical capabilities.
Effective problem-solving and conflict resolution skills.
Sound decision-making abilities.
Proficient PC skills.
Strong presentation capabilities.