Charter Global
Registered Nurse
Charter Global, Baltimore, Maryland, United States, 21276
Title: Registered Nurse - RN/LPN (HEDIS)Duration: 6 Months+Location: Baltimore, MD (Remote Job)Rate: $40-42/hr on W2
Purpose:The Clinical Medical Review Nurse (an RN with clinical experience) will report to the Clinical Support Supervisor HEDIS and be part of the Quality Team. The main duties include conducting thorough HEDIS overreads in line with NCQA guidelines. Additional tasks involve helping with Medical Record Retrieval for HEDIS and Risk Adjustment, participating in internal audits for Supplemental Data, and supporting other needs within the Quality Department.ESSENTIAL FUNCTIONS:50% Accurately and efficiently over-read medical record abstractions performed by the HEDIS abstraction staff on a daily basis according to HEDIS specifications and company training guidelines.Complete the over-read process in the Software Application, including comments if errors are found. Correct errors identified through over-read process, including a re-review of charts that may contain similar errors.Identify and report abstraction errors and provide measure re-education with the abstractor.Utilizes various software applications to support HEDIS operations by entering data and / or changing chase status for the identified chase(s).Maintains productivity level as determined by the QI Department.Maintain compliance with all HIPPA and member confidentiality requirements.
25% Medical Record Retrieval, Abstraction and Research during the Medical Record Review Project25% Medical Record Retrieval for Risk Adjustment, internal Supplemental Data Audit (PSV) and other Quality and HEDIS related tasks in the off-seasonRequired Experience:Must be a RN OR LPN with HEDIS in the recent experience - atleast 5 years with HEDIS - specially HEDIS overreads aspectMedical professional with overreads HEDIS6 years of overall experience with Nursing - clinical back side nursing 2-3 years - Quality, NCQARecent HEDIS abstractions / overreads experience in the payer/health insurance side of HEDIS or with a HEDIS vendor (ex. Cotiviti, Inovalon, Reveleer)Bachelor's degree in Nursing, Associates Degree in Nursing, Diploma in Nursing
Purpose:The Clinical Medical Review Nurse (an RN with clinical experience) will report to the Clinical Support Supervisor HEDIS and be part of the Quality Team. The main duties include conducting thorough HEDIS overreads in line with NCQA guidelines. Additional tasks involve helping with Medical Record Retrieval for HEDIS and Risk Adjustment, participating in internal audits for Supplemental Data, and supporting other needs within the Quality Department.ESSENTIAL FUNCTIONS:50% Accurately and efficiently over-read medical record abstractions performed by the HEDIS abstraction staff on a daily basis according to HEDIS specifications and company training guidelines.Complete the over-read process in the Software Application, including comments if errors are found. Correct errors identified through over-read process, including a re-review of charts that may contain similar errors.Identify and report abstraction errors and provide measure re-education with the abstractor.Utilizes various software applications to support HEDIS operations by entering data and / or changing chase status for the identified chase(s).Maintains productivity level as determined by the QI Department.Maintain compliance with all HIPPA and member confidentiality requirements.
25% Medical Record Retrieval, Abstraction and Research during the Medical Record Review Project25% Medical Record Retrieval for Risk Adjustment, internal Supplemental Data Audit (PSV) and other Quality and HEDIS related tasks in the off-seasonRequired Experience:Must be a RN OR LPN with HEDIS in the recent experience - atleast 5 years with HEDIS - specially HEDIS overreads aspectMedical professional with overreads HEDIS6 years of overall experience with Nursing - clinical back side nursing 2-3 years - Quality, NCQARecent HEDIS abstractions / overreads experience in the payer/health insurance side of HEDIS or with a HEDIS vendor (ex. Cotiviti, Inovalon, Reveleer)Bachelor's degree in Nursing, Associates Degree in Nursing, Diploma in Nursing