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HEDIS Medical Review Nurse - LPN
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Information Technology company
Contract
Information Technology company
Jacksonville, FL ( Map it )
No permanent US residency required
W-2 only
Jacksonville, FL
Contract

Required Licenses and Certifications
Active Licensed Practical Nurse

  • State Licensure

???????JOB SUMMARY:

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 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 LPN 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 large workload

Preferred: Disease management and Home Health experience is helpful. Required Experience:

  • Active Florida LPN 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.

Required Education: High School Diploma or GED LPN training

Skills
Skill Proficiency Years Experience Percent Used
Medical Records
1 - 3100%
Nursing
1 - 3100%
HEDIS
1 - 375%
Microsoft Excel
1 - 375%
Admin
Any25%
Home Health
Any25%
Position Recruiter
Luda Melanich
luda@cloudteam.com
813-868-3833