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QM Nurse Consultant - HEDIS Supplemental Data Review - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Phoenix, AZ Phoenix, Arizona |
About this job
POSITION SUMMARY
Position is responsible for obtaining, reviewing, abstracting and data entering medical records utilized for HEDIS supplemental data processes. Position may also participate in the annual HEDIS medical record review audit including medical record abstraction and chase overreads, coordination with the health plan HEDIS project managers, as well as the assistance with HEDIS interventions including member and provider mailings, provider site visits, data analysis to identify trends and root cause analysis, and other tasks as assigned.
Fundamental Components:
Understand the NCQA HEDIS technical specifications for the designated HEDIS supplemental data measures.
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.
Candidate MUST be located in AZ
BACKGROUND/EXPERIENCE required:
Registered Nurse with HEDIS medical record audit experience
3-5 years of clinical experience required
Preferred:
Managed Care experience preferred
EDUCATION
The highest level of education desired for candidates in this position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse is required
TECHNOLOGY EXPERIENCES
Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User
Technical - Desktop Tools/Microsoft Word/4-6 Years/End User
Technical - Desktop Tools/Microsoft Explorer/4-6 Years/End User
Technical - Desktop Tools/Adobe Acrobat Suite v5/1-3 Years/End User
REQUIRED SKILLS
General Business/Applying Reasoned Judgment/ADVANCED
General Business/Turning Data into Information/ADVANCED
Leadership/Driving a Culture of Compliance/FOUNDATION
DESIRED SKILLS
Technology/Leveraging Technology/FOUNDATION
General Business/Demonstrating Business and Industry Acumen/ADVANCED
Leadership/Collaborating for Results/ADVANCED
Telework Specifications:
Flexible telework / office-based schedule (can live near any office location)
Option for telework maybe evaluated after a certain period of employment, depending on applicants current telework status
ADDITIONAL JOB INFORMATION
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.
Employment Type Regular Career Band Description Professional
Position is responsible for obtaining, reviewing, abstracting and data entering medical records utilized for HEDIS supplemental data processes. Position may also participate in the annual HEDIS medical record review audit including medical record abstraction and chase overreads, coordination with the health plan HEDIS project managers, as well as the assistance with HEDIS interventions including member and provider mailings, provider site visits, data analysis to identify trends and root cause analysis, and other tasks as assigned.
Fundamental Components:
Understand the NCQA HEDIS technical specifications for the designated HEDIS supplemental data measures.
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.
Candidate MUST be located in AZ
BACKGROUND/EXPERIENCE required:
Registered Nurse with HEDIS medical record audit experience
3-5 years of clinical experience required
Preferred:
Managed Care experience preferred
EDUCATION
The highest level of education desired for candidates in this position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse is required
TECHNOLOGY EXPERIENCES
Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User
Technical - Desktop Tools/Microsoft Word/4-6 Years/End User
Technical - Desktop Tools/Microsoft Explorer/4-6 Years/End User
Technical - Desktop Tools/Adobe Acrobat Suite v5/1-3 Years/End User
REQUIRED SKILLS
General Business/Applying Reasoned Judgment/ADVANCED
General Business/Turning Data into Information/ADVANCED
Leadership/Driving a Culture of Compliance/FOUNDATION
DESIRED SKILLS
Technology/Leveraging Technology/FOUNDATION
General Business/Demonstrating Business and Industry Acumen/ADVANCED
Leadership/Collaborating for Results/ADVANCED
Telework Specifications:
Flexible telework / office-based schedule (can live near any office location)
Option for telework maybe evaluated after a certain period of employment, depending on applicants current telework status
ADDITIONAL JOB INFORMATION
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.
Employment Type Regular Career Band Description Professional