Work as a Hedis nurse, Abstracting records from nine different measures, using QSHR(Inovalon) software system.
- HEDIS Nurse at Blue Cross Blue Shield of IL.
- LPN at Symphony
- Lpn at AMN Healthcare
- Lpn at Extended care
2 months at this Job
- - Nursing
HEDIS Nurse BCBST/Adecco - Knoxville, TN February 2019 to Present Contract RN with BCBST during HEDIS project, hired to contact multiple physician offices and go to those offices to obtain and review members charts in order to bring information back to BCBST to be abstracted and entered into system according to requirements by NCQA.
- HEDIS Nurse at BCBST/Adecco
- Director of Nursing at Sunrise Communities of Tennessee
- RN Case Manager/Care Coordinator at ETSU Pediatrics
- RN- Interim Director at Physicians Regional Wound Center
at this Job
- Associates - Nursing
Maintain HIPPA regulations for consumer privacy and complete tasks in a timely manner. Ensure compliance with NCQA, federal, state and other regulatory standards. Collect data from a variety of electronic (EMR) and paper sources from provider’s offices. Conduct reviews of the data/records to ensure abstraction accuracy clinical data elements for HEDIS reporting. Document findings in HEDIS database tool (Inovalon) Meeting and maintaining quality requirements of 98% review accuracy
- HEDIS Nurse at Blue Cross Blue Shield (Aerotek)
- Hemodialysis Registered Nurse, Dialysis Center at DaVita
- Registered Nurse at Apollo Home Health Care Inc
- Registered Nurse, Medical/Surgical at Medical Surgical Unit
2 months at this Job
- Associate - Nursing
- Bachelor's - Computer Information Systems and Management
- Master of Science - Nursing
Contract Position Complete comprehensive and thorough medical record review to extract medical record data per National Committee for Quality Assurance (NCQA) specifications for the 2019 Medicaid HMO HEDIS project · Educate medical group providers and staff on Illinois state clinical standard guidelines related to documentation · Collect, analyze, and abstract medical chart data & record results into Inovalon certified software
- HEDIS Nurse at BCBS of Illinois
- Complex Care Coordinator at Cook County Health & Hospitals
- Clinical Care Coordinator at PCC Community Wellness
- Registered Nurse at Eating Recovery Center
2 months at this Job
- Bachelor of Science in Nursing - Nursing
- Bachelor of Arts in Psychology - Psychology
Duties: HEDIS RN- Partnership HealthPlan of California, Fairfield Review and abstract from medical records (in both electronic medical record systems and/or paper charts) to support reporting of HEDIS measures. - Perform accurate and comprehensive reviews of medical records timely, while maintaining appropriate HIPAA privacy and security standards. - Identify the medical information that supports the specific HEDIS measure specifications. - Enter extracted data into designated software system. - Work with the Quality Improvement HEDIS team to identify and share best practices and opportunities for improvement. - Participate in medical record inter-rater activities as required. - Report daily on Medical Record Review productivity. - Attend and participate during HEDIS team meetings. - Establish and maintain effective interpersonal relationships with all levels of staff, agencies, members, providers, and the general public.
- HEDIS Nurse at Yoh, A Day & Zimmermann Company
- Registered Nurse/Research Assistant at The San Francisco Institute of Aesthetic & Regenerative Medicine/Biometrix Inc.
- OR Staff RN at Kaiser Permanente
- Staff RN Neuro Crani Pod at UCSF Medical Center
1 year at this Job
- Diploma - Surgical Technology
- Bachelors of Science Degree - Nursing
- Associates of Science Degree - Nursing
• Collect data for ambulatory medical record reviews and compliance with provider preventive health and chronic disease outcome improvement intervention.
• Assess vendor-delegated abstraction activities and compare results to HEDIS standards and/or custom or other measure set standards
• Review medical records and abstract data for HEDIS and other measure sets in compliance with standards
• Track and report on issues and outcomes related to abstractions and over-reads
• Communicate outcomes of abstraction and over-sight activities with health plans and vendors when required
• Perform other quality initiatives as necessary.
• Make and confirm site visit appointment, prior to the date of appointment.
• Locate and review all assigned medical charts, copy all supporting documentation per specifications and data enter into the applicable software system.
• Prepares reports and quality improvement studies in an accurate, concise and timely fashion.
• Ommunicates with external data sources as needed to gather data necessary to measure identified outcomes
• Complete assigned abstraction and data entry each day.
• Provide timely notification to office of need to cancel/change appointment.
• Online data abstraction and data entry of the medical information that is needed.
• Worked with physicians, other clinicians as well as facility management to assess the situation and report on progress toward the goal of meeting HEDIS guidelines and improving overall patient care.
• Collect and summarizes performance data and identifies opportunities for provider improvement.
• Pursues methods to ensure receipt of data required for trending and reporting of various QI work plan metrics.
• Assist in activities to prioritize clinical and service improvement initiatives.
• Ensure that documentation produced and /or processed complies with state regulations.
- HEDIS NURSE at UNITED HEALTH GROUP
- CHARGE NURSE at KESWICK MULTI CARE CENTER
- PRIOR AUTHORIZATION NURSE at AMERIGROUP COMMUNITY HEALTH
- CHARGE NURSE at JENNIFER ROAD DETENTION CENTER
4 months at this Job
- Certificate - Practical Nursing
Work remotely under the direction of the Hedis Clinical Lead and Quality Director. Accurate medical record review of charts collected from provider offices and the abstraction of critical data from medical records. Ensure they are in compliance with Hedis measures, legible and contain member identifying information, such as name and date of birth. Chart abstraction, data collection and related activities, as assigned. Collaborate with non-clinical personnel regarding collection of medical records from physician offices for additional medical record pursuits.
- Hedis Nurse, Duties at MEDIX
- Nursing Care Manager, Duties at PERSIVIA
- Nurse, Duties at LIFE CARE CENTER OF ACTON
- Nurse, Duties at WINGATE AT READING
1 year, 2 months at this Job
- Associate - LPN
Complete comprehensive and thorough medical record review and over reads to extract medical record data per NCQA specifications for the health plan's HEDIS project.
- HEDIS Nurse Reviewer (Contract) at Rose International (Aetna)
- LVN at Alliance A+ Home Health Care
- Quality Assurance Coordinator at M&L Medical Services
- Nurse Reviewer (Contract) at HEDIS
2 months at this Job
- Pursuing certification in Long Term Care Administrator Program
- Bachelor's - Business Administration
Perform medical record reviews to support improvement and compliance. Abstract HEDIS data, to include over-read of reviews, searching claims, and opening SR tickets. Work collaboratively with internal HEDIS STARs Team and the Quality Team Perform administrative functions to include; medical record request, faxing, and making calls Maintain organization, updated reporting of activities with clear documentation. Track, monitor and report on the status of records and volume of work. Complete claim research to identify the service performed, dates of service, provider type, and plans of service.
- Hedis Nurse Abstractor at Florida Blue
- Utilization Review Nurse at Florida Blue Insurance
- Nurse Care Coordinator/Practice Manager at FIU Health
- (COM) Practice Manager at FIU Health College of Medicine Broward
6 months at this Job
- MBA - Health Care
- Bachelors of Arts - Health Service Administration
- Associates in Arts - Pre Nursing
- License - Practical Nurse
Obtaining medical records and reports. Verification of Members, and Abstracting information from Medical records, pharmacy reports and pursuing for compliant data. Create summaries and report to our Director. Over reading and imputing HEDIS Measures required by NCQA into Navigator. Emailing secured documents accordingly. Communication with a multitude of people for coordination of resolving matters.
- HEDIS Nurse Specialist at Kelly Services
- Quality improvement Nurse at Caloptima
- Preoperative and GI RN at SCA La Veta Surgery Center
- Comprehensive RN at Orange County Corrections Department
3 months at this Job