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Quality Management Nurse Associate 3
Ref No.: 18-25289
Location: New Albany, Ohio
Locations: we are looking for reviewers specifically in Cincinnati, Columbus, and Toledo

HEDIS Reviewer: The assignment will encompass medical chart data collection from provider offices; abstraction from medical records received via mail, fax, or electronic submission; and data entry of all abstracted data from assigned medical records into the applicable software system.
Primary Duties:
- Make and confirm all assigned site visit appointments (prior to the date of appointment)
- Notify office of need to cancel/change appointment
- Locate and review ALL assigned medical charts, perform online medical review and abstraction, annotate all supporting documentation per specifications in medical record, and data enter into the applicable software system
- Conduct follow-up provider calls to all assigned offices deemed non-responsive to requests and provide patient pull list via fax as needed
- Successfully pass all HEDIS measure testing and maintain productivity and data entry accuracy requirements
- Perform overreads of completed medical record reviews, as assigned, for quality assurance
- Participate in weekly project status calls and training calls as scheduled
- Licensed Practical Nurse or Registered Nurse (preferred)
- Registered Health Information Technician
- Minimum of 1 year of HEDIS medical record review experience (preferred)
- Knowledge of HEDIS and ability to read and interpret medical record documentation
- Professional demeanor and good work ethic.
- Conscientious problem solver, willing to learn, and take personal pride and accountability for their work performance/accuracy.
- Excellent verbal and written communication skills – clear, concise and appropriate
- Appropriate telephone etiquette when conducting provider outreach calls
- Experience using portable scanners, iPads, flash drives and laptops to capture, save, rename, and transfer confidential information (preferred)
- Computer savvy: Intermediate knowledge of Microsoft Word, Excel, Access and Outlook required. Know how to copy and paste, sort, filter, format, and save a file to a folder.
- Must be able to lift 25 lbs.
- Must dress in business casual attire and maintain a professional appearance
- Proven organizational and time management skills
- Be flexible and work under pressure (awareness of and ability to meet deadlines).
- Must keep all information collected in a safe, organized and confidential manner.
- Commit to duration of the project with the understanding that work hours can be varied.
- Inform employer if they accept employment with another MCO/temp agency to perform HEDIS reviews as the temporary employee would have access to proprietary information
- Commit to attend training for the project in main office in New Albany, OH.
- Have reliable transportation as may be required to travel up to 100 miles (or more) to obtain medical records from provider offices.