California – Remote HEDIS Medical Record Reviewer RN/LPN/LVN

Job Overview

  • Clinical License LPN, LVN, RN
  • State(s) CA

A HEDIS Medical Record Reviewer is needed for a major health insurance carrier in California!

Accepting LPN/LVNs and RNs for this position!

Flexible hourly rate, 100% remote! Can sit anywhere in California

4 month contract position

Day to Day Responsibilities of this Position and Description of Project:
– This position will be in support of the HEDIS Medical Record Review (MRR) cycle. The individuals will work directly with HEDIS MRR Program Manager and other medical record reviewers to review medical record.
– Primary responsibility will be to perform medical record review, & enter findings into abstraction tool (Inovalon QSHR) and to over read
– Identify chase opportunities & track progress
– Coordinate with Program Manager, and administrative staff to manage caseload for teams
– Communicate with team members to effectively manage project assignment

Internal/External Groups with which the Candidate will interface with:
Internal – Medical Record Review team members, but not limited to Medical Record Reviewers and HEDIS coordinators
External – Providers/Medical office staff

– This project impacts the line of Quality Reporting through HEDIS Medical Record Review chart abstraction

Required Skills (top 3 to 5/ non-negotiables):
– Preferred with previous 1-2 years of in-season HEDIS Medical Record Review experience
– Must be proficient in computers and conducting most/all work activities on computer only
– Ability to read and navigate clinical medical records in looking for specifically sought information
– Strong attention to detail and accuracy is essential
– Ability to maintain a high volume of abstractions

Nice to have:
– Colorectal Cancer Screening (COL)
– Controlling High Blood Pressure (CBP)
– Comprehensive Diabetes Care (CDC)
– Cervical Cancer Screening (CCS)
– Childhood Immunization Status (CIS)
– Immunizations for Adolescents (IMA)
– Lead Screening in Children (LSC)
– Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescent (WCC)
– Prenatal and Postpartum Care (PPC)
– Transitions of Care (TRC)
– Care for Older Adults (COA)
– Medical record review chart abstraction/overreading/ training

Education Requirement:
– Preferred RN, LVN/LPN, Certified Medical Assistant or certified coder
– Preferred with previous 2 years of on-season HEDIS Medical Record Review experiences

Software Skills Required:
– Preferred Inovalon QSHR, Adobe Standard, and Microsoft Office Suite (especially Microsoft Excel)

Required Certifications:
– Preferred RN, LVN/LPN, Certified Medical Assistant, or certified coder


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