Responsible for assisting, coordinating, developing, implementing, and evaluating adherence with the health plan's quality processes. Assists in managing and completing assigned tasks based on defined indicators, gaps in the process, and other activities as prescribed by the Manager. Responsibilities include monitoring and evaluating related performance goals and escalating gaps as appropriate. Collaborates with others in the Quality & Population Health teams or other organizational areas, as needed. Assists in maintaining activities required by or for state and federal (DMAS and CMS) and accreditation (NCQA) regulations and requirements. Ensures Quality processes and outcomes comply with all applicable accreditation standards and regulatory requirements. Serves as a Subject Matter Expert for the team. Where deficiencies are identified, assists with coordinating retraining. Assists with educating members and/or providers as required -3 Year experience in the specified area of need, insurance industry or healthcare -Medical record review/data abstraction experience -Ability to negotiate with practitioners and providers

• Licensed Practical Nurse (LPN) - Maine - Maine
• Licensed Practical Nurse (LPN) - Louisiana - Louisiana
• Licensed Practical Nurse (LPN) - Kentucky - Kentucky
• Licensed Practical Nurse (LPN) - Kansas - Kansas
• Licensed Practical Nurse (LPN) - Iowa - Iowa
• Licensed Practical Nurse (LPN) - Indiana - Indiana
• Licensed Practical Nurse (LPN) - Idaho - Idaho
• Medical Assistant - Delaware - Georgia
• Licensed Practical Nurse (LPN) - Florida - Florida
• Licensed Practical Nurse (LPN) - Delaware - Delaware
• Licensed Practical Nurse (LPN) - Colorado - Colorado
• Licensed Practical Nurse (LPN) - Arkansas - Arkansas
• Licensed Practical Nurse (LPN) - Arizona - Arizona
• Licensed Practical Nurse (LPN) - Alabama - Alabama
• Licensed Practical Nurse (LPN) - Other/National
• Licensed Practical Nurse (LPN) - Wyoming - Wyoming
• Licensed Practical Nurse (LPN) - Wisconsin - Wisconsin
• Licensed Practical Nurse (LPN) - West Virginia - West Virginia
• Licensed Practical Nurse (LPN) - Virginia
• Licensed Practical Nurse (LPN) - Utah - Utah
• Licensed Practical Nurse (LPN) - Texas - Texas
• Licensed Practical Nurse (LPN) - Tennessee - Tennessee
• Licensed Practical Nurse (LPN) - South Dakota - South Dakota
• Licensed Practical Nurse (LPN) - South Carolina - South Carolina
• Licensed Practical Nurse (LPN) - Oklahoma - Oklahoma
• Licensed Practical Nurse (LPN) - North Dakota - North Dakota
• Licensed Practical Nurse (LPN) - North Carolina
• Licensed Practical Nurse (LPN) - New Mexico - New Mexico
• Licensed Practical Nurse (LPN) - New Jersey - New Jersey
• Licensed Practical Nurse (LPN) - New Hampshire - New Hampshire
• Licensed Practical Nurse (LPN) - Nebraska - Nebraska
• Licensed Practical Nurse (LPN) - Montana - Montana
• Licensed Practical Nurse (LPN) - Missouri - Missouri
• Licensed Practical Nurse (LPN) - Mississippi - Mississippi
• Licensed Practical Nurse (LPN) - Maryland - Maryland

POSITION OVERVIEW

The HEDIS Nurse role will be responsible for the coordination, on-site and EMR data collection, and data entry and/or uploading of HEDIS data abstracted from medical records. The sole purpose of this position is for HEDIS data collection and related activities, as assigned. This position is seasonal. Travel is required.

POSITION DUTIES AND RESPONSIBILITIES

Primary responsibilities include:

• Planning, organizing and coordinating HEDIS data abstraction activities to include, but not limited to:
• Attend on-site medical record reviews as required
• Conducting medical record reviews
• Uploading medical records and entering data into software
• Working with the HEDIS Senior Manager and HEDIS Team Lead to identify and share best practices and opportunities for quality improvement
• Other HEDIS activities, as assigned

MINIMUM EDUCATION REQUIREMENTS

• License/Certification: Current and Valid Registered Nurse or Licensed Practical Nurse with a license to practice nursing in the Commonwealth of Virginia

SPECIAL KNOWLEDGE AND/OR SKILLS

• HEDIS experience
• Medical record abstraction experience
• Ability to communicate effectively verbally and in writing
• Computer literate
• Ability to use Microsoft Excel proficiently (must pass test)

WORK BACKGROUND/EXPERIENCE

• HEDIS experience, preferably in a managed care environment

PHYSICAL REQUIREMENTS

• Physical health sufficient to meet the ergonomic standards and demands of the position.

• Associate's Level Degree
• Diploma
• Certificate

• Quality Improvement 3 years
• Medical Records Data Previous Experience

• Troubleshooting
• Quality Control Analysis
• Monitoring
• Microsoft Office
• Critical Thinking