HEDIS® Review Nurse (RN or LPN) - Health Plan
Boston, MA (Fully Remote)
*** This is a Benefits Available, CONTRACT opportunity, expected to last through the HEDIS season, meaning May 2021! ***
HEDIS Nurse Duties & Responsibilities:
HEDIS Nurse Background:
- The Quality Management HEDIS Review Nurse coordinates and performs offsite and onsite data collection and data entry.
- The Nurse is responsible for complete and accurate medical record review of charts collected from provider offices and the abstraction of critical data from medical records received via fax, mail, or electronic means for all HEDIS measures for the senior population.
- The Nurse will be responsible for planning, organizing and coordinating HEDIS data abstraction activities.
- The Nurse will apply structured auditing criteria to medical records to determine compliance with standards of the performance measures; and accurately enter the results of chart audits into a database.
® “HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).
- Valid, unrestricted state nursing license ( R.N. or L.P.N.).
- Possess recent experience in at least 1 season of HEDIS data abstraction; experience must be from the last 3-5 years.
- Strong analytical mind, with problem solving and investigative skills, an aptitude for accuracy, and attention to detail.
- Ability to review and extract significant data from medical records.
- Knowledge and experience of medical terminology, medical record systems, and statistically reliable sampling methods.
- Knowledgeable of the Health Plan Employer Data Information Set (HEDIS), as well as standards and reporting requirements for Medicare, Medicaid, and applicable state plans.
- Requires working knowledge of MEDENT (EMR).
- Must be computer literate and knowledgeable in MS Office, E-mail and EMR systems, and multiple additional programs including word processing, and data management. Strong working knowledge of EZ-CAP preferred.
- Ability to prioritize work load in a fast-paced environment; and work independently with minimal supervision.
- Possess superior verbal and written communication skills, able to interface with business and medical professionals.
- Must be willing and able to travel in area, if needed.