Job Attributes

Work Schedule/Shift

Not Available

Job ID

5000366418806

Req. No

70026339

Job Title

RN HEDIS

Region

CHRISTUS System Office

Category

Registered Nurse (RN)

Division

Not Defined

Company

CHRISTUS Health

Travel

1-10%

Facility

Corp USFHP-55100

Address

919 Hidden Ridge
Irving, TX  75038
US

Type

Full Time

Apply Now RN HEDIS Job in Irving

This position is responsible for ongoing HEDIS collection and improvement activities at the health plan and reports to the Quality Manager.

Primary Responsibilities:

Coordinates and performs offsite medical record reviews to determine appropriate coding and billing practices, compliance with quality metrics, compliance with service delivery and quality standards, and where assigned investigation of quality of care and member complaints relative to quality of care and service.

Support continuum of member care by identifying members in need of health education, case management, etc.

Provide clinical expertise to Medical groups and key high volume providers, which will include but not limited to, HEDIS/STAR measures education, gap listing engagement, workflow process improvements, improved documentation practices.

Supports the HEDIS medical record chase to support optimum HEDIS, STAR ratings and other quality metric reporting.

Work collaboratively with Data Analyst to develop stronger and more real-time EMR integration efforts

Assist in the development of new HEDIS/STARS interventions and corrective action plans for measures that fall below goals

Supports quality improvement program studies requesting records from providers, maintaining databases, and researching to identify members' provider encounter history

Participates in and represents plan at community, health department, collaborative and other organizational meetings focusing on quality improvement, member education, and disparity programs, as assigned

Performs annual medical record evaluation, follow - up education, and practitioner intervention Enter documentation of findings, in identified database

Develop and maintain the HEDIS training manual.

Participates in meetings, training and in-service education, as required.

Qualifications:

Current TX RN license in good standing. Bachelor's degree in Nursing or Related field preferred. LVNs will be considered depending on clinical experience.

Experience working in a Managed Care or Provider office setting; or HEDIS experience

Experience with Medicare HCC Risks and ICD-10 and CPT codes preferred

Must possess excellent written and verbal communication skills, and have demonstrated experience with presentations.

Must have experience with Microsoft Office (Word, Excel, and Power Point) and be proficient in working with computers and databases.

Must be able to collect, synthesize and analyze data and make recommendations to improve outcomes and meet goals

Must have excellent organizational skills, be able to work with minimal supervision, demonstrated leadership experience and have a team-oriented approach.

Detail oriented, be able to meet production standards, initiate new processes to improve quality care and train Providers as needed.

Must be Professional, have a good work ethic, be a conscientious problem solver and be results-oriented

Must be adaptable, willing to learn, and take personal pride in their work.

Apply Now
Not ready to apply? Join our Talent Pool