Pay: $45.00 per hour
Hours: Monday-Friday 8 am-5 pm PST
Location: Remote **Must work PST hours**
Job Description
- Responsible for conducting clinical quality audits for Quality department
- Identify and coordinate clinical audits to determine potential areas for quality improvement within the PHP network
- Collects data by way of chart extraction, using objective specifications for HEDIS program
- Audits include review of outpatient medical records, hospital records, clinical lab and pharmacy records
- Responsible for collecting data based on standardized methodologies and organizes the data to identify and address opportunities for improvement
- Responsible for completion of Quality monitoring and chart abstraction audits. Quality audits include but are not limited to: patient health information, clinical testing and follow up, quality or provider services and medical management, medical record requirements, and other quality requirements as defined by the health plan, performance measurement specifications
- Be able to investigate perceived gaps in care identified through claims in order to identify documentation necessary to support exclusions or numerator hits. Use claims information to track where memebers has recevied care.
- Conduct clinical reviews using medical record/medical information. Use audit tools, conduct
Requirements:
- Active & unrestricted RN license in state they live
- Min. 2+ years of experience in quality management/improvement, utilization review auditing and electronic health records (EHR)
- Must have worked a minimum of 2 seasons as an actual HEDIS reviewer for a health plan
#INDAS
Job Types: Full-time, Contract
Pay: $45.00 per hour
Experience:
- HEDIS Reviewer: 2 years (Required)
- HEDIS Audit: 2 years (Required)
License/Certification:
- RN License (Required)
Work Location: Remote