A client of Insight Global's is looking for HEDIS RNs or LPNs for a partially remote contract position in PA and NJ. PARTIALLY remote position as it may require onsite reviews at provider offices based on needs of the area. Schedule is flexible. Remote aspects include contacting/scheduling provider onsite reviews, requesting records from providers via fax, abstraction & entry of medical records assigned by a Clinical Quality Lead nurse. Miles will be reimbursed for any travel. Computer equipment, encrypted zip drives and mobile phones are provided for uploading, transferring and scanning files to our secure file transfer site. 2 weeks of virtual training will be provided and required.
RESPONSIBILITIES will include (but not limited to):
* Contacting/scheduling provider offices & traveling to onsite medical record reviews (mileage, tolls, parking reimbursed)
* Communicate effectively and professionally with office managers, health systems and any other facility or care providers
* Scan/Upload/Download medical records from onsite reviews daily
* Medical record abstraction into database from onsite visit, assigned remote charts
* Highlighting member demographics & HEDIS evidence using Adobe Acrobat Reader
* Reviewing Overreads for any corrections and addressing each daily
* Abide by all Code of Conduct, HIPAA, and patient confidentiality requirements
* Attend & successfully complete remote training for first two weeks of project. Training includes attending HEDIS measure training via MS TEAMS, testing for proficiency, computer-based company training. Training is paid.
Must choose one (or multiple) territories preferred:
PA NORTH - Montgomery & Bucks counties and a small amount of Lehigh County
PA CENTRAL -- Greater Philadelphia Area
PA SOUTH - Delaware and Chester counties and Northern Delaware state
NJ NORTH -- North NJ Counties, Monmouth, Middlesex counties
NJ SOUTH -- South NJ Counties, Mercer, Ocean counties
* Previous HEDIS review experience or experience with Utilization Review, Quality, Medical Record auditing
* Bachelors Degree
Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.