• Nurse Reviewer/Auditor

    Job Locations US-VA-Glen Allen
    Job ID
    2018-4927
  • About Us

    Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier.
    By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.
     
    At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.
     
    If this sounds like you, read on! 

    Overview

    The HEDIS Nurse Reviewer/Auditor role will be responsible for the coordination, on-site and telephonic data collection, and data entry and/or uploading of HEDIS data abstracted from medical records. This incumbent is also responsible for yearlong auditing/over reading of HEDIS medical records. The sole purpose of this position is for HEDIS data management and related activities, as assigned. Travel is required. This is an in office Richmond VA based position.

    Responsibilities

    Primary Reviewer responsibilities include:

    • Planning, organizing and coordinating HEDIS data abstraction activities to include, but not limited to:
      • Scheduling and coordinating on-site medical record reviews
      • Conducting HEDIS Education Site Visits with Providers and Staff
      • Conducting medical record reviews
      • Uploading or data entering outcomes
    • Ensuring that HEDIS processes and outcomes comply with all applicable accreditation standards and regulatory requirements
    • Providing clinical quality management and ad-hoc reporting services, as assigned
    • Working with the Team Lead, Senior Manager, Director and other designated staff to identify and share best practices and opportunities for quality improvement

    Primary Auditor responsibilities include:

    • Serve as a Subject Matter Expert for the department
    • Year-long over reading/auditing of medical records loaded in the supplemental database and during the annual HEDIS project
    • Where deficiencies are identified, abstractors will be retrained
    • Assist with educating providers on their HEDIS report cards and gap in care reports
    • Other HEDIS related activities, as assigned

    Qualifications

    MINIMUM EDUCATION REQUIREMENTS 

    • Current and Valid Registered Nurse with a license to practice nursing in the Commonwealth of Virginia

    SPECIAL KNOWLEDGE AND/OR SKILLS 

    • Completion of at least one HEDIS project (4 to 6 months)
    • Medical record abstraction experience
    • Ability to negotiate with practitioners and providers
    • Ability to communicate effectively verbally and in writing
    • Computer literate
    • Exposure to ICD-10 and CPT4 coding

    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.

     

    All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

     

    Our mission is to inspire healthy living within the communities we serve!

    Options

    Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
    Share on your newsfeed

    Need help finding the right job?

    We can recommend jobs specifically for you! Click here to get started.