This is a work at home role with 25-50% of travel required throughout Phoenix, AZ.
Schedule is Monday-Friday standard business hours. No nights, no holidays and no weekends!
Experienced HEDIS record review nurse will be responsible for obtaining, reviewing, abstracting and data entering medical records utilized for HEDIS® supplemental data processes. Candidate must understand the NCQA HEDIS® technical specifications for the designated HEDIS® supplemental data measures, be able to apply understanding of the technical specifications in the process to review, abstract and data enter supplemental data, collaborate with the health plan HEDIS® project managers and other health plan departments (which may include but is not limited to member services, provider relations and integrated care management) to achieve the common goal of improving member outcomes, as measured by the HEDIS®/STAR measures. Must be comfortable with accessing a variety of EMR systems remotely to obtain and abstract medical record data per specifications. May need to conduct onsite visits to obtain, review, abstract and data enter all medical record data for large groups/groups that request an onsite visit.
Reviews documentation and abstracts compliant medical record data for entry into supplemental data tool. Professional customer service demeanor a plus as staff may be required to contact the providers of record, vendors, or internal Aetna departments to
obtain additional information. Commands a comprehensive knowledge of NCQA HEDIS and STARS Measures for both Medicare
and Medicaid, with recent experience in the annual HEDIS audit. Staff will work on a variety of electronic tools and must be
comfortable with technology and Microsoft Word, Adobe Acrobat, and Windows 10. High level of accuracy and attention to detail are a must for this position. The ideal candidate is self-motivated and comfortable working under tight deadlines.
- Must have reliable transportation and be willing and able to drive within assigned geographic area (maximum of 60 miles)
- Ability to read and interpret medical records, including handwritten records
- Professional demeanor and good work ethic; Self-motivated,
- Conscientious problem solver, willing to learn, takes personal pride in their work performance/accuracy
- Proven organizational and time management skills required
- Excellent verbal communication skills – clear, concise and appropriate required
- Computer savvy: Microsoft Excel, Outlook, and Adobe preferred.
- 3+ years of Medical Record Review experience with HEDIS-specific measure review is highly preferred
- Experience with a variety of EMR systems highly preferred
- RN with current unrestricted state licensure active for Arizona required
Additional Job Information
Telework requires the ability to self-motivate and be a proactive employee. Volume and accuracy expectations will be communicated and are expected to be met. Work requires the ability to read and interpret medical record documentation, both computer-generated and hand written.
Sitting at work station for extended periods of time typing on the computer.
Ability to multi-task, prioritize and effectively adapt to a fast-paced changing environment
Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
Effective communication skills, both verbal and written
Bachelor's degree or equivalent experience
Percent of Travel Required
25 - 50%
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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