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HEDIS Nurse Reviewer Job
Date: Nov 20, 2009
Location: Merrifield, VA, US
Job Title:
HEDIS Nurse Reviewer
Job ID:
10141
Location: Merrifield, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular
JOB SUMMARY: Responsible for performing and collecting data collection and medical record activities to support the Health Plan's Quality Management Work Plan
PRIMARY RESPONSIBILITIES:
1. Integrates data collected from a variety of sources including to but not limited to: medical records, immunization registries, member documents and provider office
2. Requests and review appropriate medical records.
3. Participates in medical record collection and validation review process for HEDIS and other projects as indicated.
4. Educate providers and office staff about medical records and clinical standard guidelines.
5. Assists in defining opportunities for improvement through analysis of patterns and trends and communicates these appropriately.
6. Communicates significant findings, including potential risk management issues to the Quality Management lead in a timely manner.
7. Performs on-site medical record reviews. Follows appropriate procedures for scheduling, requesting, and reviewing records while on-site at provider offices and hospitals.
Prepare additional reports as needed.
8. Collaboratively works with other departments.
9. Other duties as assigned.
EDUCATION AND EXPERIENCE:
Education
Required: Licensed Practical Nurse (LPN)/Registered Nurse (RN) in Plan state
Preferred: Bachelors degree
Years and Type of Experience Required:
Required: Minimum of two (2) years of clinical experience
Preferred: Experience with medical record abstraction processes
Specific Technical Skills
Required:
· Excellent interpersonal, organizational, problem solving, analytic and communication skills
· Appreciation of cultural diversity and sensitivity towards target population
· Professional phone etiquette
· Ability to work calmly and effectively under adverse conditions
· Computer keyboard and work processing proficiency
Preferred: Bi-lingual preferred
Certifications or Licensure
Required:
· Current LPN/RN licensure in Plan state
· Must possess a valid driver's license, required insurance, and vehicle
Preferred: None
Other
Required: Ability to work evening and weekends as needed
Preferred: Established working relationship with community providers
SCOPE INFORMATION
Item Measure
· # Direct Reports None
· # Indirect Reports None
· Budgetary $ Responsibility Complete expense reports monthly
PHYSICAL REQUIREMENTS
· Must be able to operate a computer
· Must be able to operate a telephone
· Must be able to operate a motor vehicle
· Must be able to operate a fax machine
· Must be able to operate a copying machine
· Local travel- must be able to travel locally to providers offices and members homes
· Must be able to communicate verbally
· Must be able to tolerate standing and sitting for long periods of time
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.
AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.
HEDIS Nurse Reviewer
Job ID:
10141
Location: Merrifield, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular
JOB SUMMARY: Responsible for performing and collecting data collection and medical record activities to support the Health Plan's Quality Management Work Plan
PRIMARY RESPONSIBILITIES:
1. Integrates data collected from a variety of sources including to but not limited to: medical records, immunization registries, member documents and provider office
2. Requests and review appropriate medical records.
3. Participates in medical record collection and validation review process for HEDIS and other projects as indicated.
4. Educate providers and office staff about medical records and clinical standard guidelines.
5. Assists in defining opportunities for improvement through analysis of patterns and trends and communicates these appropriately.
6. Communicates significant findings, including potential risk management issues to the Quality Management lead in a timely manner.
7. Performs on-site medical record reviews. Follows appropriate procedures for scheduling, requesting, and reviewing records while on-site at provider offices and hospitals.
Prepare additional reports as needed.
8. Collaboratively works with other departments.
9. Other duties as assigned.
EDUCATION AND EXPERIENCE:
Education
Required: Licensed Practical Nurse (LPN)/Registered Nurse (RN) in Plan state
Preferred: Bachelors degree
Years and Type of Experience Required:
Required: Minimum of two (2) years of clinical experience
Preferred: Experience with medical record abstraction processes
Specific Technical Skills
Required:
· Excellent interpersonal, organizational, problem solving, analytic and communication skills
· Appreciation of cultural diversity and sensitivity towards target population
· Professional phone etiquette
· Ability to work calmly and effectively under adverse conditions
· Computer keyboard and work processing proficiency
Preferred: Bi-lingual preferred
Certifications or Licensure
Required:
· Current LPN/RN licensure in Plan state
· Must possess a valid driver's license, required insurance, and vehicle
Preferred: None
Other
Required: Ability to work evening and weekends as needed
Preferred: Established working relationship with community providers
SCOPE INFORMATION
Item Measure
· # Direct Reports None
· # Indirect Reports None
· Budgetary $ Responsibility Complete expense reports monthly
PHYSICAL REQUIREMENTS
· Must be able to operate a computer
· Must be able to operate a telephone
· Must be able to operate a motor vehicle
· Must be able to operate a fax machine
· Must be able to operate a copying machine
· Local travel- must be able to travel locally to providers offices and members homes
· Must be able to communicate verbally
· Must be able to tolerate standing and sitting for long periods of time
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.
AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.
Nearest Major Market: Washington DC
Job Segments: Healthcare, Nursing
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