HEDIS Nurse - SCAN Temp
About The Position
The HEDIS Nurse reviews medical records for Quality Initiatives and HEDIS reporting, abstracts clinical data according to NCQA guidelines and internal procedures, and conducts outreach to members and providers to collect information needed for complete records and reporting. The role participates in interdepartmental initiatives and makes phone calls to members to discuss medication adherence and care gaps, such as bone density testing and colorectal cancer screenings. The position may also support projects and interventions across departments, including HCS and Pharmacy. It requires reviewing and abstracting medical records, documenting member interactions, pursuing missing information, coordinating with HEDIS staff, and working toward project objectives and timelines. The role is temporary and remote.
Requirements
- Associate's degree, equivalent experience, or a technical degree.
- Registered Nurse (RN) or Licensed Vocational Nurse (LVN) credential required.
- 2–3 years of related experience.
- Knowledge of the field's policies, procedures, and practices.
- 0–1 years of leadership experience; the posting describes Level I supervisors as typically having little authority for personnel.
Responsibilities
- Abstract clinical data from medical records in accordance with NCQA guidelines and internal procedures.
- Communicate with members and providers about Quality Initiative projects to help improve quality of care.
- Enter findings into the designated database.
- Accurately document interactions with members as specified by the project manager.
- Identify medical-record pursuit opportunities and work with pursuit assistants to retrieve records information.
- Evaluate clinical information and determine how to obtain needed information from members or providers to meet project objectives.
- Pursue missing data throughout the records-review process.
- Follow project manager directives and meet project objectives within established timelines.
- Coordinate with HEDIS staff to update and track medical records for reporting.
- Support projects or interventions within or across departments as needed, including HCS and Pharmacy.
- Review medical records and abstract pertinent information to meet project requirements.
- Maintain professional and technical knowledge through educational workshops, professional publications, networks, and professional societies.
- Support SCAN's vision and goals and perform other duties as assigned.
Benefits
- Medical benefits
- Paid sick time
- 401(k) retirement savings plan
- Employee recognition program
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
