HEDIS Medical Review Nurse - RN
Information Technology company
Information Technology company
W-2 onlyUS ResidentContractContract to Permanent878 views
Jacksonville, FL 32256
ContractContract to Permanent
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The Quality HEDIS Medical Review Nurse performs medical record reviews, abstract HEDIS data according to the HEDIS Technical Specifications to include over-reads.
The essential functions listed represent the major duties of this role, additional duties may be assigned.
- The reviewer will collaborate with the HEDIS vendor and perform over-read on reviews.
- Perform administrative functions to include: medical record request, faxing, and calls to members and providers as needed.
- Required to track, monitor and report status of records and volume of work
- Collaborate with a vendor to resolve issues
- Complete claim search to identify the service performed, date of service, provider type, and place of service. Research may include multiple systems and reports
- Be familiar with the Medical Record Abstraction Tool, BI Tool, Diamond system, Healthcare Analytics tool, JIVA, SharePoint and vendor systems.
- Document accurately in the vendor's tool and the Medical Record Abstraction Tool
- Maintain productivity
- Handle calls professionally
Job Requirements
- Active Florida Nursing License with two (2) years of related work experience
- Knowledge of medical terminology
- Experience with medical record/quality review experience. HEDIS/Stars preferred
- Experience applying nationally recognized criteria
- Must be proficient in Microsoft Office (Word, Excel, Outlook) as well as Internet research skills
- Excellent computer skills
- Ability to navigate through multiple systems and screens or medical review requests
- Talking and typing simultaneously
- Effective time management skills
- Effective interpersonal and communication skills
- Ability to use electronic medical record and claims systems
- Problem-solving abilities
- Work respectfully, cooperatively, positively, and collaboratively in an interdisciplinary team
- Organizational skills are very important; must be able to work independently to complete tasks with minimal direction.
- Ability to manage, and prioritize work tasks to adhere to deadlines and identified time frames
- Ability to think analytically and make decisions
- Ability to manage a large workload
Preferred
- Disease management and Home Health experience are helpful.
Required Experience
- Active Florida RN 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.