Quality Assurance Nurse Reviewer

3 days ago

Atlanta, Georgia, United States Spectraforce Technologies Inc Full time
Job Title: Quality Assurance Nurse Reviewer

Job Description:

  • The Quality Assurance Nurse Reviewer will work under the direction of the HEDIS Quality Assurance Team Lead and other company personnel to perform quality assurance reviews on medical records.
  • The candidate will validate abstracted medical record data and enter findings electronically into a specified database to support HEDIS Reporting and Quality Improvement.
  • The HEDIS Quality Assurance Nurse Reviewer may be required to perform other duties toward HEDIS collection as assigned, including HEDIS medical record review and outreach for collection of medical records.
  • This is a fast-paced environment, and candidates must adhere to measured productivity and accuracy requirements.
  • The candidate is required to attain a score of 100% on specific measure testing prior to conducting live medical record reviews and overreads.
  • Candidates must also be able to achieve and maintain a quality reliability score of 95% or higher to remain eligible for employment for the duration of the project.
Required Skills:
  • Follow established procedures for conducting Quality Assurance Overread reviews of abstracted medical records.
  • Extract electronic medical record data using multiple systems.
  • Enter pertinent data from paper and electronic medical records into the database as required by established quality assurance abstraction procedures.
  • Communicate effectively and professionally.
  • Meet or exceed productivity and accuracy requirements.
  • Ability to work independently and in a team environment.
  • Excellent time management and prioritization skills.
  • Excellent communication skills (written and verbal).
  • Strong attention to detail.
  • Ability to multi-task.
  • Flexibility with assignment change.
  • Highly organized.
  • Evidence of strong computer skills, including the Microsoft Office suite (e.g., Microsoft Outlook, Excel, and Word).
  • Maintain patient confidentiality by protecting patient information from unauthorized disclosure.
  • Other duties as assigned.
Education/Experience:
  • RN or LPN/LVN license.
  • 3-5 years of recent HEDIS experience preferred.
  • Quality improvement or medical record review experience preferred.
  • Computer experience (i.e., Excel, Word, Outlook) required.
About Us:

Spectraforce Technologies Inc is a leading provider of staffing solutions, with a global client service delivery model powered by a state-of-the-art AI proprietary talent acquisition platform. We offer a range of services, including contingent, permanent, and statement of work (SOW) services, to clients in various industries, including technology, financial services, life sciences, healthcare, telecom, retail, utilities, and transportation.

Benefits:

Spectraforce Technologies Inc offers a comprehensive benefits package, including ACA-compliant health benefits, dental, vision, accident, critical illness, voluntary life, and hospital indemnity insurances to eligible employees. Additional benefits include commuter benefits, a 401K plan with matching, and a referral bonus program. We also provide unpaid leave and paid sick leave when required by law.

Equal Opportunity Employer:

Spectraforce Technologies Inc is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, age, sexual orientation, gender identity, genetic information, disability, or veteran status, or any other category protected by applicable federal, state, or local laws.

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