HEDIS NURSE
On-site · New York City, New York, United States
Job Summary
Special Project Nurse/Medical Professional will be responsible for completing auditing and/or medical records review projects. Responsibilities include medical records reviews, data collection, chart abstractions, reporting and analyses. Must have good communication skills to interface with United Health Services personnel and be very detailed oriented. This position is responsible for HEDIS data collection and reports to the Quality Management Manager. Coordinates and performs onsite medical record reviews at provider offices; supports HEDIS medical record chase to support optimum HEDIS and quality metric reporting; supports quality improvement, requesting records from providers, maintaining databases, and researching to identify members' provider encounter history; enters documentation of findings in identified database; RN/LPN; 5+ years clinical experience, or other relevant experience; 2+ years of quality improvement experience, or other relevant experience; MUST HAVE PRIOR HEDIS EXPERIENCE (at least 1-2 season); knowledge of Medicaid/Medicare regulations; travel to physician offices if required; strong organizational skills and ability to work independently and with teams; proficient with MS Excel and Word/Outlook; able to develop tactical plans and drive performance; excellent communication skills.
Required Qualifications
- RN
- LPN
- MUST HAVE PRIOR HEDIS EXPERIENCE (at least 1-2 season)
- 2+ years of quality improvement experience
- strong experience using MS Excel
- Experience working in Medicaid and/or Medicare health care and insurance industry
- Knowledge base of clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements
- Ability to travel to physician offices if required; valid state-specific driver's license and reliable vehicle
- Strong organizational skills and ability to work both independently and with teams
- Ability to evaluate medical records with attention to detail
- Ability to interact with medical staff, peers, and internal company staff at all levels
- Ability to use databases and prepare reports as needed
- Proficiency in software applications that include, but are not limited to, Microsoft Word, Microsoft Excel, Outlook
- Demonstrated ability to assist with focusing activities toward a strategic direction as well as develop tactical plans, drive performance and achieve targets
- Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
- Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand
- All your information will be kept confidential according to EEO guidelines.
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