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HEDIS Medical Review Nurse Specialist

2 months ago

Baltimore, Maryland, United States nTech Workforce Full time

Job Summary

nTech Workforce is seeking a skilled HEDIS Medical Review Nurse to join our Quality Team. As a key member of our team, you will be responsible for conducting thorough HEDIS overreads in accordance with NCQA guidelines.

Key Responsibilities

  • Assist with Medical Record Retrieval for HEDIS and Risk Adjustment
  • Participate in internal audits for Supplemental Data
  • Support various needs within the Quality Department

Requirements

  • 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
  • Ability 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

Preferred Qualifications

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