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Hedis Review Nurse Remote Jobs

Review Appraiser - Remote | Wfh
By Get It Recruit - Real Estate At Orlando, FL, United States

Primary Responsibilities As a Review Appraiser at oue company, you will be instrumental in maintaining the quality and accuracy of our property valuation processes. Your key responsibilities ...

Remote Nurse Specialist Jobs
By Revitalist At , Remote From $26 an hour
●Must be fluent and have the skills and ability to conduct Zoom, Google Meet remote meetings.
● Conducting remote clinical consultations for ketamine, home ketamine, and Spravato therapy.
● Minimum of 5 or more years nursing experience
● Excellent written and verbal communication skills
This position is full time.
● Promotes a culture of professionalism, accountability, and engagement.
Hedis Coordinator - Remote
By ASK Consulting At ,
100 % Remote - candidates must have reliable;
Expiry Date: 15 September 2023
Process medical records received for HEDIS and other related projects
Index medical records into systems
Call provider offices to confirm medical record contact information
Fax medical record requests to provider offices
Remote Registered Nurse - Medical Review Specialist
By Avosys Technology, Inc. At San Antonio, TX, United States
Years of experience in supporting, administering, managing content management platform such as Sharepoint
years of experience in supporting, administering, managing content management platform such as Sharepoint
Maximize family time with no weekend, Holiday, or on-call requirements
Take advantage of our competitive, comprehensive benefits package including medical, dental, vision, life, short-term disability, long-term disability & 401(k)
Ensure that all documentation includes a valid signature consistent with the signature requirements
Complete one-on-one provider education (i.e., webinar, conference call, etc.) within 30 days of sending out review results letter
Physician, Inpatient Concurrent Review (Pt/Remote) (Ur Exp. Not Req'd)
By CorroHealth At , Remote From $100 an hour
Quality of life with a remote predictable part-time schedule*
Comprehensive training and education program
You have the ability to work remotely in a comfortable environment
MD or DO degree with strong acute care clinical knowledge
Adult Internal Medicine, Emergency Medicine, Hospitalist, Nephrology, Surgeon or Infectious Disease; Board certification (preferred)
Working knowledge of hospitals’ EMR
Sr. Abstractor, Hedis/Quality Improvement (Remote In Ia)
By Molina Healthcare At , Des Moines $21.82 - $42.55 an hour
REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
To all current Molina employees:
Hedis Quality Nurse Dfw
By INTEGRANET HEALTH At , Dallas
Knowledge of computer systems and applications. Skill in planning, organizing, prioritizing, delegating and supervising.
Partners with physicians/physician staff to find ways to explore new ways to encourage member clinical participation in wellness and education.
Provides resources and educational opportunities to provider and staff.
Provides IPA approved communication such as newsletter articles, member education, outreach interventions and provider education.
Ensures that documentation produced and/or processed complies with state regulations and/or accrediting body requirements.
Skill in exercising initiative, judgment, problem-solving, decision-making.
Review Team Lead - Remote
By DISCO At , Remote
3+ years of document review experience at a law firm, in-house legal department, consulting firm, or managed review provider
2+ years of quality control experience on managed review projects
Be one of the principal internal points of contact for review teams during DISCO Managed Review projects
Assist the Review Manager with providing reviewers with necessary feedback and guidance to deliver industry leading speed and accuracy
Work closely with Review Managers and other internal DISCO stakeholders by providing feedback and feature requests
Strong understanding of AI capabilities and applications
Hedis Nurse - Remote | Wfh
By Get It Recruit - Healthcare At Raleigh, NC, United States
Organizational Skills: Your strong organizational skills will help you manage tasks efficiently and deliver results.
Collaborate with the HEDIS team to retrieve medical records, employing your excellent communication skills to contact providers.
Showcase your knowledge of medical terminology and nursing expertise throughout the process.
HEDIS Experience: Prior experience in HEDIS Medical Record Review is highly preferred.
Nursing Qualifications: Hold an ADN (Associated Degree in Nursing) and be a registered nurse (RN).
Supportive Team: Join a collaborative team of professionals who value your contributions and foster a positive work environment.
Senior Hedis Analyst (Remote)
By Relevante, Inc. At United States
Minimum 5 years of work experience in healthcare and/or managed care.
Manage the HEDIS lifecycle process for multiple plans.
Develops and implements data-driven solutions to meet business requirements by producing analytics, reports, and data sets.
In collaboration with the HEDIS manager to develop annual HEDIS project plans and monitor the HEDIS project plans for multiple LOBs.
Assures the ongoing high-performance level of the overall department through continued knowledge acquisition and knowledge sharing with co-workers
Experience and ability to utilize a certified HEDIS software
Review Clerk (Remote) Jobs
By Acentra Health At Philadelphia, PA, United States
Are you an experienced Review Clerk looking for a new challenge?
Do you value care management and quality improvement?
Knowledge of medical terminology and experience in a healthcare setting preferred.
Perform data entry of individual case review and reviewer information into the case review database as necessary.
Assist Case Review Managers in following up with reviewers for specific cases via communication by telephone, e-mail, or fax.
Prior experience and/or training in secretarial capacity preferred.
Technical Review Supervisor - Remote
By PosiGen At Harahan, LA, United States
Supervise, train, and develop the Channel Technical Review Service team and offer help with solving issues
Conduct remote site inspections confirming PV installation was installed per our standards and meets Building and Electric code
Work with team on daily, weekly, and monthly goals of completing remote site inspections
Keep up with code changes and requirements for all partner markets
Research code requirements, procedures or processes for new markets
Manage the accuracy and timely approval of partner quality assurance submissions
Project Manager Iii (Healthcare, Hedis) - Remote
By RemoteWorker US At Greensboro, NC, United States
4+ years of project management and implementation or program management experience.
Proficient with MS Office applications and project management tools.
Strong knowledge of healthcare quality measures, Medicare STARS, Medicaid Quality Rate System, regulatory reporting requirements, and business intelligence solutions highly preferred.
Experience working with and leading diverse groups and matrix managed environments.
Bachelor's degree in Business Administration, Healthcare Administration, related field, or equivalent experience. Master's degree preferred.
PMP certification highly preferred .
Advisor, Supervision- Trade Review (Remote Option Available)
By Raymond James Financial At , Saint Petersburg, 33716, Fl
Any equivalent combination of experience, education, and/or training approved by Human Resources.
Salary Range: CO, NY, CA, WA (based on Education, Work Experience, and Geographic Location)
Performs other duties and responsibilities as assigned.
Suitability and other compliance issues involved with branch manager/FA trading activity.
Independently manage and complete multiple projects and tasks; work independently with minimal direct supervision.
Use appropriate interpersonal styles and communicate effectively and professionally, both orally and in writing, with all organizational levels including branch managers/FAs.
Medical Review Nurse (Snf Focus)
By Performant Financial Corporation At , Remote
Experience with utilization management systems or clinical decision making tools such as Medical Coverage Guidelines (MCG) or InterQual.
Working collaboratively with the audit team to identify and obtain approval for particular vulnerabilities and/or cases subject to potential abuse
Work in partnership with our clients, CMD colleagues, and other contractors on improving medical policies, provider education, and system edits
Strong preference for experience performing utilization review for an insurance company, Tricare, MAC or organizations performing similar functions
Experience with ICD-9, ICD-10, CPT-4 or HCPCS coding.
Knowledge of insurance programs program, particularly the coverage and payment rules.
Medical Review Nurse (Readmissions Focus)
By Performant Financial Corporation At , Remote
Experience with utilization management systems or clinical decision-making tools such as Medical Coverage Guidelines (MCG) or InterQual.
Experience with ICD-9, ICD-10, CPT-4 or HCPCS coding.
Knowledge of insurance programs program, particularly the coverage and payment rules.
Excellent written and verbal communication skills.
Ability to manage multiple tasks including desk audits and claims review.
Minimum of three years diversified nursing experience providing direct care in an inpatient or outpatient setting.
Medical Review Nurse Rn - Remote
By Florida Blue At , $64,800 - $81,000 a year
Experience with utilization management systems or clinical decision-making tools such as: Medical Coverage Guidelines (MCG), CMS guidelines, and/or InterQual
Review all requests not approved by the non-clinical support rep to determine benefit coverage and medical necessity
At least two (2) years clinical experience
Excellent written and verbal communication skills
Experience working with multiple research/processing systems
Experience working with MS Word, Excel, and PowerPoint
Part Time Concurrent Review Nurse Rn -Remote
By Florida Blue At , $64,800 - $81,000 a year
Experience with the Healthcare industry and Managed Care
Experience in MS Word and Excel
 Income protection benefits: life insurance, Short- and long-term disability programs;
 Additional voluntary benefits available; and
Current RN - Registered Nurse - State Licensure And/Or Compact State Licensure Florida
Occasional travel within the State of Florida
Care Review Processor -Virginia (Remote)
By Molina Healthcare At , Long Beach, 90802, Ca $15.58 - $30.39 an hour

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

To all current Molina employees:

Care Review Processor -Virgina (Remote)
By Molina Healthcare At United States
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Provides telephone, clerical, and data entry support for the Care Review team.
Responds to requests for authorization of services submitted via phone, fax, and mail according to Molina operational timeframes.

Are you looking for an exciting opportunity to use your nursing skills from the comfort of your own home? We are looking for a Hedis Review Nurse to join our team and help us ensure the quality of our healthcare services. You will be responsible for reviewing medical records and data to ensure accuracy and compliance with quality standards. If you are a detail-oriented professional with a passion for quality healthcare, this is the perfect job for you!

Overview Hedis Review Nurse Remote is a position that involves reviewing medical records to ensure that they meet the standards set by the National Committee for Quality Assurance (NCQA). The nurse is responsible for ensuring that the medical records are accurate and up-to-date, and that they meet the requirements of the NCQA. The nurse must also be able to interpret the data and make recommendations for improvement. Detailed Job Description The Hedis Review Nurse Remote is responsible for reviewing medical records to ensure that they meet the standards set by the NCQA. The nurse must be able to interpret the data and make recommendations for improvement. The nurse must also be able to identify any discrepancies in the medical records and provide feedback to the healthcare provider. The nurse must also be able to provide guidance to the healthcare provider on how to improve the quality of care. Job Skills Required
• Knowledge of NCQA standards and regulations
• Ability to interpret medical records
• Ability to identify discrepancies in medical records
• Ability to provide feedback to healthcare providers
• Ability to provide guidance to healthcare providers on how to improve the quality of care
• Excellent communication and interpersonal skills
• Ability to work independently and as part of a team
• Ability to work in a fast-paced environment
Job Qualifications
• Bachelor’s degree in Nursing or related field
• Current RN license in the state of practice
• At least two years of experience in a clinical setting
• Knowledge of NCQA standards and regulations
• Knowledge of medical terminology
Job Knowledge
• Knowledge of NCQA standards and regulations
• Knowledge of medical terminology
• Knowledge of healthcare industry
• Knowledge of healthcare regulations
• Knowledge of healthcare technology
Job Experience
• At least two years of experience in a clinical setting
• Experience in reviewing medical records
• Experience in providing feedback to healthcare providers
• Experience in providing guidance to healthcare providers on how to improve the quality of care
Job Responsibilities
• Review medical records to ensure that they meet the standards set by the NCQA
• Interpret the data and make recommendations for improvement
• Identify any discrepancies in the medical records and provide feedback to the healthcare provider
• Provide guidance to the healthcare provider on how to improve the quality of care
• Monitor the progress of the healthcare provider in meeting the standards set by the NCQA
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