HEDIS Nurse - SCAN Temp

SCAN Health Plan•Long Beach, CA

7d•Remote

About The Position

The HEDIS Nurse reviews medical records for Quality Initiatives/HEDIS® reporting and conducts outreach to members and providers in coordination with departmental campaigns to collect data and support complete medical records and reporting. The role participates in interdepartmental initiatives that involve phone discussions with members, primarily about medication adherence and procedures needed to close care gaps, such as bone density testing and colorectal cancer screenings. For HEDIS® projects, the nurse abstracts clinical data according to NCQA guidelines and internal procedures, communicates with members and providers about quality initiatives, enters findings into designated databases, and documents member interactions as specified by the project manager. The nurse identifies opportunities to retrieve records, evaluates clinical information to obtain needed data, pursues missing information, follows project directives and timelines, and coordinates with HEDIS® staff to update and track records for reporting. As needed, the nurse supports projects and interventions within or across departments, such as HCS and Pharmacy. This includes reviewing medical records and abstracting information to meet project requirements. The position also supports SCAN’s vision and goals and may perform other assigned duties. This is a temporary, remote opportunity with a stated base wage of $40 per hour.

Requirements

Associate's degree, equivalent experience, or a technical degree.
Registered Nurse (RN) or Licensed Vocational Nurse (LVN) required.
2–3 years of related experience.
0–1 years of leadership experience.
Knowledge of the field’s policies, procedures, and practices.
Ability to lead and direct the work of other employees; the posting notes that Level I supervisors typically have little personnel authority.

Responsibilities

Abstract clinical data from medical records according to NCQA guidelines and internal procedures.
Communicate with members and providers about Quality Initiative projects and help improve quality of care.
Conduct outreach to members and providers to collect information, including discussing medication adherence and procedures needed to close care gaps.
Enter findings into the designated database and document member interactions as specified by the project manager.
Identify record-retrieval opportunities and work with pursuit assistants to obtain medical record information.
Evaluate clinical information to determine how to obtain needed information from members and providers for project objectives.
Pursue missing data throughout the record review process.
Follow project manager directives and timelines to meet project objectives.
Coordinate with HEDIS® staff to update and track medical records for reporting.
As needed, support projects or interventions across departments, including HCS and Pharmacy.
Review medical records and abstract pertinent information to fulfill project requirements.
Maintain professional and technical knowledge through educational workshops, professional publications, personal networks, and professional societies.
Support the achievement of SCAN’s vision and goals and perform other duties as assigned.