Remote HEDIS Reviewer Team Lead (RN)

Job Overview

  • Clinical License RN
  • State(s) Nationwide
At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering a whole bunch of smart, big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, and technology. We want to throw the long ball with people we love for a cause we believe in.  Life is short.  Join us.

 

Job Description

A bit more about this role: 

We are looking for a HEDIS Lead Clinical Quality Reviewer who has knowledge and experience reviewing Medicare Records. This role will be part of the team that is scaling up Devoted’s HEDIS processes. As a member of this team – you’ll be critical in continuing to scale and evolve the processes and systems for efficient and quality medical record review not only during the official HEDIS season, but also for year-round data capture. This person will play a pivotal role in helping Devoted deliver quality outcomes and 5-star rating required to ensure we take care of our members as we would our own family.

 

Responsibilities will include:

  • Support year-round review of medical records to support HEDIS gap closure
    • Maintain and improve on existing processes
    • Leverage EHR access of key provider groups to capture relevant patient-level information
    • Audit supplemental files from provider groups
  • Oversee a team of off-shore reviewers to ensure accuracy and efficiency of chart reviews
    • Maintain and improve on operating policies
    • Overread and give feedback and guidance for continuous improvement
  • Lead Medical Record Review process for official HEDIS sample
    • Over-read abstractions
    • Oversee data and timely clinical quality findings in compliance with HEDIS technical specifications into Inovalon’s QSHR tool.
    • Support chart chase strategy
  • Maintain current knowledge of Devoted medical record review process and NCQA HEDIS technical specifications
  • Maintain HIPAA regulations for consumer privacy and complete tasks in a timely manner, ensure compliance with NCQA, federal, state and other regulatory agency standards
  • Maintain 98% accuracy on medical record reviews and overreads.
  • Perform annual audit of Devoted’s Medical Records according to AAAHC standards

 

Required Skills:

  • 2+ years of experience handling Medical Record reviews
  • Associate’s and/or Bachelor’s Degree in Nursing
  • Knowledge of HEDIS specifications
  • Microsoft Office/G-Suite proficient (Access, Excel, PowerPoint, Word, etc.)
  • Solid problem solving and time management skills
  • Great interpersonal skills
  • Excellent communication skills (written and verbal)
  • Strong attention to detail
  • Highly organized
  • Self-starter and comfortable working in a fast-paced, ever changing environment

 

Desired Skills:

  • 3+ years of Quality Improvement experience in a Healthcare and/or Managed Care setting
  • Knowledge of Inovalon QSHR

 

Healthcare equality is at the center of Devoted’s mission to treat our members like family.  We are committed to a diverse and vibrant workforce.  If you lack a specific credential for this position but believe that your strengths and life experiences will propel our mission, we would love to hear from you.

 

If you love running towards complex challenges and transforming them into solutions, if you want to make a potentially huge impact on many lives, and if you are looking for a disruptive startup with an inspiring and talented team, Devoted Health may be the place for you!

 

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.

 

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.

 

COVID-19 Vaccination Requirement: Where permitted by applicable law, candidates must have received or be willing to receive the COVID-19 vaccine by date of hire to be considered. The Company will provide reasonable accommodations to qualified employees with disabilities or for a sincerely held religious belief, practice, or observance.

 

 

 

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