HEDIS Nurse Reviewer Jobs in USA, Remote | Rose International Job

Required Education:• Verifiable High School Diploma or equivalentRequired Certifications/Licenses:• Must have either an RN, LPN, or LVN licenseRequired Qualifications/Skills/Experience:• 4 or more seasons of experience auditing and abstracting medical records required• Candidate must commit to attending all required training and conference calls assigned for the project• Candidate must return all equipment that is supplied to them in good working condition and in a timely manner at the end of the project• Medical knowledge/terminology is required• Ability to read and interpret medical records• Professional demeanor and good work ethic• Computer savvy: Microsoft Word, Excel, email, and Adobe Reader required. Know how to save a file to a folder• Excellent verbal and written communication skills – clear, concise and appropriate• Conscientious problem solver, willing to learn, and take personal pride in their work performance/accuracy• Exceptional attention to detail and excellent analytical, investigation, and problem-solving skills• Proven organizational and time management skills, including the ability to meet required deadlines• Must keep all information collected in a safe, organized and confidential manner while maintaining confidentiality of PHI, HIPAA Privacy and Security RulesHEDIS Nurse Reviewer Overview:• Participates in the collection and review of medical records to abstract clinical information for HEDIS quality reporting• Training will be provided prior to the start of the assignment• This position interprets relevant clinical criteria through review of medical records, annotates via Adobe PDF and populates a data collection tool to support compliance with HEDIS and CMS performance measures• Ensures accurate and complete documentation of required information to meet risk management, regulatory, and accreditation requirements • The candidate must be proficient with databases and with conducting 100% of work activities on the computer• Must commit to the duration of the project with the understanding that work hours can be varied. Due to proprietary information, must inform employer if they are planning to accept employment with another companyJob Duties:• Complete assigned abstraction and data entry each day• Work with provider offices as needed to schedule/confirm appointments, follow up on medical record submission, and provide patient rosters• Locate and review ALL assigned medical charts, perform abstraction, copy all supporting documentation per specifications and data enter into the applicable software system ALL assigned abstracts• Prioritize and accurately complete tasks within established times• Identifying trends and documentation of areas for improvement• Maintaining project productivity levels while maintaining accuracy requirements for abstraction and data entry activitiesIndustry: HealthcareEstimated Start Date: 01/05/2026**Only those lawfully authorized to work in the designated country associated with the position will be considered.** **Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements.**