HEDIS Clinical Review Nurse, LVN 25-00443

POSITION : HEDIS Clinical Review Nurse, LVN

Title : Hybrid (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA)

Position Type : Temporary / Temp-Hire

Schedule : M-F, 8 : 00 am - 5 : 00 pm

Assignment Length : 6 months

DESCRIPTION

• Interpret, clarify, and implement changes accurately through the maintenance of current knowledge of HEDIS technical specifications
• Demonstrate the ability to accurately apply technical specifications when performing chart reviews and communicate changes and clarifications to impacted business units within the organization, as appropriate to perform the primary function of medical record validation and support education / outreach based on required NCQA standards
• Support outreach and education projects related to HEDIS, Supplemental Data, and other quality improvement initiatives. Research and develop training materials, conduct presentations and information sessions, or provide targeted outreach about Historical Supplemental Data, NCQA HEDIS Technical Specifications, and other quality activities / medical record review projects
• Act as a liaison between the Quality Improvement / HEDIS department and other departments, practitioners, and providers in support of HEDIS-related programs and activities
• Collaborate with HEDIS improvement Nurse to develop and conduct HEDIS trainings to IEHP departments and Providers in support of IEHP's Quality Programs and goals
• Review medical record submissions for supplemental data, in support of IEHP's audit standards and requirements for HEDIS reporting
• Review all medical record abstractions with a high attention to detail to ensure IEHP is compliant with the high-quality standards set for HEDIS medical record audits
• Participate in medical record abstraction and accuracy validations (overreads) for various HEDIS efforts, such as the annual hybrid pursuit, prospective chart reviews, and other quality improvement project reviews
• Appropriately escalate quality assurance concerns to HEDIS RN or CQI Supervisor for final determination of NCQA or HEDIS compliance

REQUIREMENTS

Key Qualifications

INDH