What are the responsibilities and job description for the HEDIS Review Nurse RN and LPN(LVN) position at PSG Global Solutions Careers?
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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 Client
Our 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
What 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?
