HEDIS Review Nurse

Review Nurse SUMMARY DESCRIPTION : The review nurse is responsible for medical record abstractions and overreads during the annual Healthcare Effectiveness Data and Information Set (HEDIS) survey. The review nurse is responsible for reviewing and accurately performing comprehensive review of medical records to abstract relevant clinical data during HEDIS. HEDIS abstractions are completed in accordance with NCQA guidelines and technical specifications. Additional responsibilities include but not limited to folder and file management, annotating medical records and saving completed documents with correct naming conventions on a shared drive as well as data entry into QSHR. ESSENTIAL FUNCTIONS : bstract medical records pply product/plan specific abstraction criteria/requirements during medical record review process Maintain defined productivity volumes Sustain accuracy rate of 95% during abstraction and data entry throughout the HEDIS survey Perform quality reviews of abstracted medical records as assigned Ensure open and honest communication with management/designee regarding development or assistance needed throughout project Escalate work related challenges/issues to Senior Director or designee ttend scheduled daily and ad-hoc meetings with HEDIS Project Manager, and /or Quality Management Specialist/ designee to discuss project status, open issues and productivity Comply with HIPAA, PHI, patient confidentiality, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies Other duties as assigned JOB REQUIREMENTS : Registered Nurse (RN)/ Licensed Practical Nurse ( LPN ) with unrestricted license 2 years' HEDIS abstraction/over-reading experience Data entry proficiency Working knowledge PDF, Word and Excel Excellent written and communication skills Database management Preferred Skills : Experience in Pediatrics, Cardiology, Endocrinology and/or Obstetrics QSHR proficiency

Created: 2024-11-05