[Hiring] HEDIS Nurse @SCAN Health Insurance

Role Description

The HEDIS Nurse reviews medical records for Quality Initiatives/HEDIS® reporting. Conducts outreach to members and/or providers in coordination with departmental outreach campaigns to collect necessary data to ensure complete medical records and reporting information. Will participate in many interdepartmental initiatives which requires phone discussions with members. The primary objective is to discuss medication adherence and specific procedures which members need to fill gaps in their care (i.e. Bone density testing, colorectal cancer screenings, etc.).

You Will

• HEDIS® Duties:
  • Abstracts clinical data from medical records per NCQA guidelines and internal procedures.
  • Works to improve quality of care by communicating with members and providers regarding various Quality Initiative projects. Enters findings into designated database.
  • Accurately documents all interactions with members in a manner specified by the project manager.
  • Identifies pursuit opportunities and works closely with pursuit assistants to retrieve medical records information.
  • Evaluates information, from a clinical perspective, to best obtain needed information from members and/or providers to complete specific objectives within the project timeline.
  • Pursues missing data to complete records review, throughout the review process.
  • Follows project manager’s directives to meet specific objectives within the project timeframe.
  • Coordinates with HEDIS® staff regarding the updating and tracking of medical records for reporting purposes.
  • Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
• Outreach Nurse Duties:
  • On an as needed basis, supports projects and/or interventions within or across departments throughout the organization (i.e. HCS, Pharmacy, etc.).
  • Accurately reviews medical records and abstracts pertinent information to fulfill specific requirements as directed by the project manager.
• We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.
• Actively support the achievement of SCAN’s Vision and Goals.
• Other duties as assigned.

Qualifications

• Associate's Degree or equivalent experience or 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.

Requirements

• Leads and directs the work of other employees.
• Level I supervisors typically have little authority for personnel.

Benefits

• This is a temporary opportunity for a limited period of time.
• Base Wage: $40 hourly.
• Work Mode: Remote.
• Medical Benefits.
• Paid Sick Time.
• Excellent 401(k) Retirement Saving Plan.
• Robust employee recognition program.
• An opportunity to become part of a team that makes a difference to our members and our community every day!