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HEDIS Medical Review Nurse
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Information Technology company
ContractContract to Permanent
Information Technology company
Jacksonville, FL ( Map it )
Jacksonville, FL
ContractContract to Permanent

Active Florida Nursing License with two (2) years of related work experience

 

  • Must have previous medical record / quality review experience; HEDIS/STARS preferred
  • Must be proficient in Microsoft Office (Word, Excel, Outlook, and PowerPoint) as well as Internet research skills
  • Ability to communicate clearly verbally and in writing 
  • Organizational skills are very important; must be able to work independently to complete tasks with minimal direction. 

Preferred:

  • Disease management experience is helpful
  • Recent experience in medical record reviews, data collection for HEDIS / Stars 


Job Description: 

  • Perform medical record reviews to support improvement and compliance, abstract HEDIS data, to include over-read of reviews, working collaboratively with internal HEDIS STARs Team and the Quality Team.
  • Perform administrative functions to include; medical record request, faxing and calls to members and providers as needed.
  • Maintain organized, updated reporting of activities with clear documentation.
  • Required to track, monitor and report on the status of records and volume of work.
  • Complete claim research to identify the service performed, dates of service, provider type, and place of service.
  • Research may include multiple systems and reports.
Skills
Skill Proficiency Years Experience Percent Used
Medical Records
1 - 3100%
Nursing
1 - 3100%
HEDIS
1 - 375%
Microsoft Excel
1 - 375%