HEDIS Review Nurse RN and LPN(LVN) Job at PSG Global Solutions Careers in Chicag

Apply now and our proprietary system will quickly have you in front of a live recruiter. The Opportunity Description We're looking for a HEDIS Review Nurse, working in Insurance industry in Chicago, Illinois, 60601, United States. An RN and LPN(LVN) is responsible for annual patient chart inspection/audit. Audits are conducted to ensure that providers (MDs) accepting insurance are in compliance with standards of patient care set forth by the insurance company. Experience with medical record review required.ESSENTIAL FUNCTIONS:Apply structured auditing criteria to abstract medical records, follow defined procedures for saving approved medical record documentation and accurately enter the results of chart audits into the health plans database, Quality Spectrum Hybrid Reporter (QSHR).Perform abstract medical record documentation submitted for HEDIS measures, used annually for reporting to National Committee for Quality Assurance (NCQA). The HEDIS measures are used to assist in measuring quality of health care provided to health plan members.Maintain productivity level with less than a 5% error rate in record abstraction and data entry on an ongoing basis.Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.Maintain complete confidentiality of company related business.Maintain effective communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested. Our ClientOur client is a fast-growing industry-recognized staffing firm. Recruiting critical IT, Financial, Engineering, Healthcare, and Data Analytics talent. With 20+ years' experience and growth. Connections in Automotive, Healthcare, Retail, Financial & Insurance, and Professional & Business Services. Working to bring top talent together with premier organizations. Big enough to have great opportunities. Small enough to care about finding the right one for you. It'sabout relationships based on mutual interest. The results are low turnover, long-lasting partnerships and growth. Want to work for a company invested in your success?Experience Required for Your Success Registered Nurse (RN) with unrestricted license in state. Clinical experienceExperience in utilization review, quality assurance, and/or medical record and site review auditsKnowledge of medical terminology standard medical practices, formal quality improvement process, and federal, state, accreditation regulations and standardsVerbal and written communications skills including interpersonal skills for meeting with physicians and office staff and representing the company using diplomatic/professional demeanorPC proficiency to include Word and ExcelWhat Do You Think?Does your experience reflect what it takes to be successful in this role? Do the work and challenges get you excited about what's possible?