Seeking a HEDIS Medical Review Nurse (LPN or RN) for a 100% Remote position. Must be licensed and reside in Florida.

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.

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.

Requirements:

• 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.
• Must have experience related to HEDIS or the related measures.

Preferred:

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