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HEDIS Review Nurse - Contract - Remote
HireOps Staffing - San Antonio, TX
posted 2 months ago
About the position
The HEDIS Review Nurse is a contract position responsible for conducting medical record abstractions and overreads during the annual Healthcare Effectiveness Data and Information Set (HEDIS) survey. This role involves reviewing medical records to extract relevant clinical data in compliance with NCQA guidelines, ensuring accuracy and productivity throughout the process. The position is fully remote and requires effective communication and collaboration with management and project teams.
Responsibilities
- Abstract medical records according to HEDIS guidelines.
- Apply product/plan specific abstraction criteria during the review process.
- Maintain defined productivity volumes and sustain an accuracy rate of 95% during abstraction and data entry.
- Perform quality reviews of abstracted medical records as assigned.
- Ensure open communication with management regarding development or assistance needed.
- Escalate work-related challenges to the Senior Director or designee.
- Attend scheduled meetings with the HEDIS Project Manager and Quality Management Specialist to discuss project status and productivity.
- Comply with HIPAA, PHI, and other corporate policies.
Requirements
- Registered Nurse (RN) or Licensed Practical Nurse (LPN) with an unrestricted license.
- 2 years of HEDIS abstraction/over-reading experience.
- Proficiency in data entry.
- Working knowledge of PDF, Word, and Excel.
- Excellent written and communication skills.
- Database management experience.
Nice-to-haves
- Experience in Pediatrics, Cardiology, Endocrinology, and/or Obstetrics.
- QSHR proficiency.
Benefits
- Remote work flexibility.
- Competitive hourly pay of $42.
