Review NurseThis is a contract assignment that will start right away and end on April 30th 2024Summary 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.Essential Functions:Abstract medical recordsApply product/plan specific abstraction criteria/requirements during medical record review processMaintain defined productivity volumesSustain accuracy rate of 95% during abstraction and data entry throughout the HEDIS surveyPerform quality reviews of abstracted medical records as assignedEnsure open and honest communication with management/designee regarding development or assistance needed throughout projectEscalate work related challenges/issues to Senior Director or designeeAttend scheduled daily and ad-hoc meetings with HEDIS Project Manager, and /or Quality Management Specialist/ designee to discuss project status, open issues and productivityComply with HIPAA, PHI, patient confidentiality, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policiesOther duties as assignedJob Requirements:Registered Nurse (RN)/ Licensed Practical Nurse (LPN) with unrestricted license2 years' HEDIS abstraction/over-reading experienceData entry proficiencyWorking knowledge of PDF, Word and ExcelExcellent written and communication skillsDatabase managementPreferred Skills:Experience in Pediatrics, Cardiology, Endocrinology and/or ObstetricsQSHR proficiency Apply To This Job