HEDIS Review Nurse
Job Description
Job Description
Remote but need to get to Newark, NJ first day to pick up equipment and orientation
This position is responsible for conducting quality audits for state audits, HEDIS and quality referral and complaints issues. This position is also responsible for preparing weekly, monthly, quarterly and year-end reports.
2. Prepares appropriate documentation to summarize on-site findings with physician, providing education and discussing opportunities for improvement.
3. Provides data support services to facilitate the process and analyze trends/patterns for quality improvement and health management.
4. Assists the Quality Management department with various special projects and focused clinical studies.
5. Performs related tasks or special studies as requested.
6. Assists in training of internal NJ Health staff, providers and vendors on programs and audit standards, both on and off site.
7. In-house representative and project lead for state audits.
8. Responsible for analysis of audit findings.
9. Produces various reports as requested.
10. Co-ordinates and manages the Corrective Action Plan (CAP) process for assigned audit type
11. Conducts reaudits ensuring prior deficiencies were addressed. 1. Requires three + years related business experience, preferably n health care industry.
2. Requires License Practical Nurse License or an active New Jersey Registered Nurse License. 1. Requires valid Motor Vehicle driver's license and access to an automobile. 1. Requires knowledge of managed care principles.
2. Requires knowledge of medical terminology.
3. Requires knowledge of PC's and related software.
4. Prefers knowledge of URAC accreditation standards and HEDIS principles.
5. Prefers knowledge of health management or patient education.
Recommended Jobs
Au Pair
Get hired for Sam's aupair Job in Watchung, NJ. Fun-Loving Playful 4 1/2 yr old twin girls need AUPAIR. Find aupair care work in Watchung.
EPIC PROJECT MANAGER FULL TIME
Job Description Job Description Join Our Team at Bergen New Bridge Medical Center !** We are dedicated to providing high-quality, compassionate care to our diverse community. As a leading heal…
Preschool Teacher
Summary Schedule: Full-Time (Monday–Friday) Compensation: $18-$22 per hour At Lawrence Day School, we believe that exceptional care starts with exceptional educators. We’re not just a…
Technical Evaluator - Camera Equipment
ProStaff Workforce Solutions is seeking a Technical Evaluator – Camera Equipment Rep for our client in Burlington, NJ. If interested, we would be excited to connect and discuss this opportunity …
Deli Counter Worker - Experience Preferred
Job Description Job Description Job Title: Deli Counter Worker Location: Tenth and Willow Deli & Market Job Type: Full or Part Time Salary: Competitive Hourly Rate Job Summary: …
Data Analyst
-- Overview: As a Data Analyst, you will be instrumental in driving the advanced data analytics strategy for Global Operations, delivering breakthrough insights that support the BBG and Carlsbad si…
ETL / Informatica Developer
Summary Min of 8 yrs of IT experience. Candidate should possess strong technical skills in ETL using Informatica and IICS. Strong experience in Data Modeling, and Analytical SQL query skills…
Call Center Representative
Job Description Job Description C+A Global is seeking a knowledgeable and dedicated Customer Service/ Call center representative to join our team. The ideal candidate will be a product expect, pr…
Customer Success Representative
Join ChristianSky Agency as a Customer Success Representative! Empower Your Career, Unlock Your Potential, and Work from Anywhere! At ChristianSky Agency, we’re on an exciting journey of growth, …
Nurse Practitioner / Physician Assistant
Job Description Job Description Benefits: ~ Life Insurance ~401(k) ~401(k) matching ~ Paid time off **Job Description** Elmora Family Practice is currently seeking for a professiona…