HEDIS Review Nurse in Chicago, IL at CRS Group

Date Posted: 1/11/2020

Job Snapshot

Job Description

Review Nurse
Duration: 6+ month contract
Location: Chicago, IL 60601
Overview: The CRS Group is currently looking for a Review Nurse for one of our clients in the Chicago area. The CRS Group is a nationwide Staffing Firm who works primarily with Fortune 500 and Fortune 1000 corporations.
Job Description:
We are looking for an RN or LPN with clinical experience and will work under the supervision of the HEDIS Coordinator. They are a member of the medical record review team. The team is responsible for obtaining and performing accurate comprehensive reviews of medical records in support of The HEDIS Effectiveness Data and Information Set project. HEDIS reviews are completed in accordance with NCQA guidelines and technical specifications.

Duties and Responsibilities:
  • Comply with appropriate procedures for scheduling, requesting, and reviewing records on-site at physician offices, hospitals and other health care facilities.
  • Initiates Fax Cover Page and Provider letter documenting medical record request.
  • Schedules and record onsite appointment in share calendar with team lead.
  • Locate and review all assigned medical charts, copy all supporting documentation per specifications and data enter into the applicable software system ALL assigned abstracts.
  • Utilizes various software applications to support HEDIS operations by entering data and / changing chase status pertaining for the identified chase(s).
  • Maintains compliance with all HIPAA and patient confidentiality requirements.
  • Participate in medical record abstraction and inter-rater reliability process as needed.
  • Maintains a less than 5% error rate in record abstraction and data entry.
  • Meets with HEDIS Coordinator and / or QI Specialists to discuss HEDIS efforts, any open issues and can include IRR results.
  • All other duties as assigned.

  • Degree, Diploma or Certificate from a school of nursing
  • Knowledge of medical terminology
  • Data entry and/or typing experience.
  • Clear and concise written and verbal communication skills.
  • PC proficiency to include Word, Excel and Lotus Notes.
  • Customer service skills

ss # 85876
Qualified applicants will receive consideration for employment without regard to race, color, age, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or genetic information.