Review Nurse

SUMMARY 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 records
Apply product/plan specific abstraction criteria/requirements during medical record review process
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
Other duties as assigned

JOB 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

Preferred Skills:
Experience in Pediatrics, Cardiology, Endocrinology and/or Obstetrics
QSHR proficiency