Title

RN QI Specialist - HEDIS Med Rec Review Abstractor 


Description Job Summary: Under the direction of the QI Manager, the QI Specialist, HEDIS Medical Record Review Abstractor, will review medical records, both electronic and hard copy for specific data elements related to the Healthcare Effectiveness Data and Information Set (HEDIS) on an ongoing basis. This individual will be responsible for all medical record review abstraction related to HEDIS and ensuring final rates are accurately reflective of CareSource health plan activities through ongoing abstraction of administrative data and input into an electronic administrative database. Performance metric will be established and monitored through ongoing audits and intrerater reliability.

Essential Functions:
• Participate in required training based on current HEDIS specifications
• Conduct medical record review abstractions accurately and efficiently as outlined in training
• Completes overreads for medical record reviews completed by chosen medical record vendor during the HEDIS medical record review season
• Meets interrater reliability audits
• Communicates effectively and professionally with provider offices and internal staff as required
• Able to work autonomously
• Ability to manage and meet workloads and deadlines
• Limited travel to assist with HEDIS medical record review abstraction
• Perform any other job related instructions as requested, with reasonable accommodation.
 

Position Requirements Minimum Qualifications:
Education:
• Bachelors Degree or equivalent.
Experience:
• 1 ' 3 years experience with HEDIS chart audits
• 1 ' 3 years experience in a managed care setting
Certification:
• Current, unrestricted RN licensure in state of practice
Technical Skills:
• Strong computer skills ' Facets, Word, Microsoft Office, Excel, and SharePoint
Knowledge & Skills
• Communication skills
• Ability to work independently and within a team environment
• Attention to detail
• Familiarity of the healthcare field
• Knowledge of Medicaid
• Critical listening and thinking skills
• Training/teaching skills
• Proper grammar usage
• Technical writing skills
• Time management skills
• Proper phone etiquette
• Customer service oriented
• Decision making/problem solving skills
• Leadership experience and skills
• Analytical and organizational skills
• Knowledge of Medical Records
 

Educational Requirements Education:
• Bachelors Degree or equivalent.
 

License Requirements Certification:
• Current, unrestricted RN licensure in state of practice
 

Full-Time/Part-Time Full-Time  

Shift Days  

Salary S14 $48094 minimum  

About the Organization CareSource is the 2nd largest Medicaid managed health care plan in the country, and our strength lies in our experience. CareSource provides a full spectrum of services for the administration of public-sector health care programs, serving more than 900,000 Medicaid consumers in Ohio and Michigan.
Our health plans are founded on the principles of quality and service delivered with compassion and a thorough understanding of Medicaid, Medicare, and the associated regulatory environments. We offer a unique approach to managed care through the process efficiencies and value-added benefits we offer to our members and the health care providers we partner with to serve them. As a managed health care organization, CareSource focuses on prevention with a goal of improving member health and the quality and accessibility of health care services for Medicaid consumers. CareSource assists in the coordination of member care by partnering with a defined network of participating doctors, hospitals and other health care providers.
CareSource Benefits
CareSource is an equal opportunity employer that offers a drug and tobacco free environment and a competitive compensation and benefits package to full-time and part-time employees who work at least 24 hours per week.
The benefits package includes:
• Health, dental and vision insurance
• Flexible spending accounts (health and dependent care)
• Life insurance
• Accidental death and dismemberment insurance
• Short- and long-term disability insurance
• 401(k) retirement plan
• Liberal paid personal time to be used on a discretionary basis for sick leave or as scheduled time off
• Eight paid holidays and a floating holiday
• Educational reimbursement

For more information about CareSource, please see About Us on our website, www.caresource.com.
 


This position is currently not accepting applications.

To search for an open position, please go to http://www.caresource.isg2.com



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