HEDIS - Nurse Reviewers
Watertown, MA 02472
HEDIS Nurse Reviewer
The HEDIS Nurse Reviewer has responsibility for ensuring the quality and timeliness of the medical record review process that supports the reporting of HEDIS hybrid measures. The position is responsible for the execution of all aspects of the scheduling, retrieval, and abstraction processes associated with the review of medical records. The HEDIS Nurse Reviewer is responsible for working independently to retrieve, review, abstract, and enter pertinent medical data required for certain HEDIS measures. The position works closely with management in evaluation, issues identification, and issues resolution. This position will also participate in ongoing HEDIS improvement activities throughout each calendar year.
- Collaborate with clinical and non-clinical staff on provider scheduling and medical record retrieval. Track and report daily medical record review progress and clinical data abstraction quality to management. Meet established goals and deadlines, report concerns; and work to make modifications and/or identify corrective actions when required to achieve goals.
- Abstract clinical information from medical records according to established policies and procedures; enter data into the medical records management system. Conduct medical record reviews either in the offices or off site at providers offices, depending on record review requirements.
- Conduct inter-rater reliability (IRR) testing following established procedures. Correct data errors and/or add additional or missing data as needed to complete each file review.
- Assist with the HEDIS Compliance Audit and HEDIS quality improvement activities as assigned. Support new initiatives as mandated by contract, accreditation, regulatory standards, and/or by the organization.
- Adhere to all privacy and confidentiality policies in accordance with Federal, State, and organizational guidelines.
- Participates in departmental, interdepartmental meetings, and other plan staff meetings as appropriate and necessary.
- Participate in ad hoc projects as necessary.
- Maintain professional growth and development through self directed learning activities. Participate in the ongoing development and growth of the Quality department.
- Maintains an active Massachusetts RN license in good standing without restrictions.
- Performs related duties as assigned.
- RN required with current active licensure in Massachusetts without restrictions. BSN or BS/BA or 4 to 7 years experience in similar environment preferred.
- Minimum of 3 years clinical experience preferred; minimum 2 years quality improvement / HEDIS preferred. Prior experience with medical record review is preferred.
- Self-motivated with ability to work independently, be highly organized, detail-oriented, and able to manage multiple activities simultaneously.
- Demonstrate proven track record for establishing, building, and managing relationships. Consistently exercises good judgment. Excellent interpersonal and communication skills are essential.
- Must be able to write and speak clearly and effectively to superiors, peers and providers. Easily maintains a high degree of professionalism in difficult situations. Experience in preparing and delivering written reports and presentations respectively preferred.
- This position requires strict confidentiality Proficiency with the Microsoft Office suite of products required. Knowledge and experience of MedMeasures and MedCapture (or other HEDIS data abstraction software) preferred. Able to demonstrate experience with cultural and ethnic diversity across all stakeholder perspectives.
Director, Client Services
Ashley Dineen has been with The Panther Group since 2009 and has worked within many areas of the company including payroll, compliance, on-boarding, recruitment, and client management.
Ashley is a mother of two and enjoys spending time with family in her spare time.