Job 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.
• 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.
• Attend 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.

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

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