HEDIS Special Projects Nurse

A Remote Hedis Specialty Project Nurse is available through Adecco Medical & Science. Quality Solutions Delivery (QSD) integrates talented individuals with expertise and experience in many areas of quality improvement, including HEDIS, CAHPS and Accreditation. Our goal is to achieve extraordinary performance that exceeds the expectations of the constituents, customers and members we serve. In this position, you will work with the Quality Solutions Delivery staff to assist with the 2020 data collection cycle.

Responsibilities:

The purposes of this role include, but are not limited to:
Market specific data collection efforts and provider outreach
Medical record review for HEDIS and HEDIS-like measures
Over-read of medical records
Candidate must be technically savvy and must be able to work without distraction. This is a high production environment, and candidates must adhere to measured productivity requirements.


Responsibilities:

Performs provider/practitioner medical record reviews for HEDIS and HEDIS-like measures as part of Quality Solutions Delivery staff
Reviews assigned medical records in order to verify clinical data elements for HEDIS reporting, e.g., results of laboratory tests, verification of hypertension and the most recent blood pressure reading, prenatal and postpartum care services
Integrates data collected from a variety of electronic and paper sources
Demonstrates proficiency in Microsoft Office: Outlook, Excel, and Word and similar applications
Manages various data organized within Excel spreadsheets
Identifies findings supported by documentation guidelines with high level of accuracy
Maintains HIPAA standards and confidentiality of protected health information; reports critical incidents immediately
Communicates identification of pursuit leads for additional medical records, if needed, to other members of the team
Attends conference calls as necessary to provide information relating to clinical reviews and compliance
Successfully completes HEDIS technical specification training and testing
Successfully completes HEDIS software training and uses software correctly
Responsible for meeting daily over read production goal
Performs other duties as assigned


Shift Start/End Time:

Example: 8:00am-5:00pm in time zone as appropriate - Flex as necessary after training - Monday - Friday
•Ability to commit to entire January - May assignment with no or minimal absences


Required Qualifications:

Minimum 1 year healthcare/health plan experience
Minimum 1 year HEDIS experience and/or knowledge
Solid knowledge of managed care requirements related to clinical quality
Research and detail oriented, excellent proof reading skills
Excellent time management and prioritization skills
Designated workplace inside home (virtual)
Reliable internet connection (virtual)
Strong communication skills
Strong proficiency with Microsoft Office applications, including: Word, Excel, Adobe and PowerPoint
Critical thinking skills
Results-driven independent worker and self-starter


Preferred Qualifications:

Clinical degree highly preferred, including, but not limited to: RN, LVN, LPN
Current, unrestricted state license in applicable field
Experience working with HEDIS software (data entry, reporting)
Experience in medical record review (vendor or health plan; onsite or fax/mail)
Experience working in EMR systems


If you are interested in this Remote Hedis Specialty Project Nurse then please click APPLY NOW. For other opportunities available at Adecco Medical and Science go to www.adeccousa.com. If you have questions about the position or would like more information, please contact Sindie Rothstein at 858-410-1108 or by email at Sindie.rothstein@adeccona.com

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Reference number US_EN_2_108175_333822