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Medical Review Nurse
Ref No.: 18-13201
Location: Doral/ Miami, Florida
Position Type:Contract
Start Date / End Date: 10/22/2018 to 05/31/2019
Job Description: Requirements:
• Active Florida Nursing License with two (2) years of related work experience
• Must have previous medical record / quality review experience; HEDIS/STARS preferred
• Must be proficient in Microsoft Office (Word, Excel, Outlook, and PowerPoint) as well as Internet research skills
• Ability to communicate clearly verbally and in writing
• Organizational skills are very important; must be able to work independently to complete tasks with minimal direction.

Preferred:
• Disease management experience is helpful
• Recent experience in medical record reviews, data collection for HEDIS / Stars

Job Description:
• Perform medical record reviews to support improvement and compliance, abstract HEDIS data, to include over-read of reviews, working collaboratively with internal HEDIS STARs Team and the Quality Team.
• Perform administrative functions to include; medical record request, faxing and calls to members and providers as needed. Maintain organized, updated reporting of activities with clear documentation. Required to track, monitor and report on the status of records and volume of work.
• Complete claim research to identify the service performed, dates of service, provider type, and place of service. Research may include multiple systems and reports.
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