Quality Assurance Nurse Reviewer (Overread Team) - (100% REMOTE) ID - 1621

Actual Job Title: Quality Clinical Management Senior Analyst - HEDIS

Duration: 4 Months

Schedule: 8:00 AM to 5:00 PM

Note: Must have a reliable internet connection and experience working in a remote setting.

Job Description
  • The Healthcare Effectiveness Data and information Set (HEDIS) Quality Assurance Nurse Overreader works under the direction of the HEDIS Quality Assurance Team Lead and other Company personnel to perform quality assurance reviews on medical records.
  • The HEDIS Quality Assurance Nurse Reviewer will validate abstracted medical record data and enter findings electronically into a specified data base to support HEDIS Reporting and Quality Improvement.
  • The candidate may be required to perform other duties toward HEDIS collection as assigned including HEDIS medical record review and outreach for collection of medical records.
  • This is a fast-paced environment, and candidates must adhere to measured productivity and accuracy requirements.
  • The candidate is required to attain a score of 100% on specific measure testing prior to conducting live medical record reviews and overreads.
  • Candidate must also be able to achieve and maintain a quality reliability score of 95% or higher to remain eligible for employment for the duration of the project.

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Required Skills
  • Follow established procedures for conducting Quality Assurance Overread reviews of abstracted medical records
  • Extract electronic medical record data using multiple systems
  • Enter pertinent data from paper and electronic medical records into database as required by established quality assurance abstraction procedures
  • Communicates effectively and professionally
  • Meet or exceed productivity and accuracy requirements
  • Ability to work independently and in team environment
  • Excellent time management and prioritization skills
  • Excellent communication skills (written and verbal)
  • Strong attention to detail
  • Ability to multi-task
  • Flexibility with assignment change
  • Highly organized
  • Evidence of strong computer skills including the Microsoft office suite (e.g., Microsoft Outlook, Excel, and Word)
  • Maintain patient confidentiality by protecting patient information from unauthorized disclosure
  • Other duties as assigned

Education/Experience:
  • RN or LPN/LVN license.
  • 3-5 years recent HEDIS medical record review experience preferred
  • Quality improvement or medical record review experience preferred
  • Computer experience (i.e., Excel, Word, Outlook) required

About Us: Established in 2004, SPECTRAFORCE® is one of the largest and fastest-growing diversity-owned staffing firms in the US. The growth of our company is a direct result of our global client service delivery model that is powered by our state-of-the-art A.I. proprietary talent acquisition platform, robust ISO 9001:2015/ISO 27001 certified processes, and strong and passionate client engaged teams. We have built our business by providing talent and project-based solutions, including Contingent, Permanent, and Statement of Work (SOW) services to over 140 clients in the US, Canada, Puerto Rico, Costa Rica, and India. Key industries that we service include Technology, Financial Services, Life Sciences, Healthcare, Telecom, Retail, Utilities and Transportation. SPECTRAFORCE is built on a concept of “human connection,” defined by our branding attitude of NEWJOBPHORIA®, which is the excitement of bringing joy and freedom to the work lifestyle so our people and clients can reach their highest potential. Learn more at: http://www.spectraforce.com

Benefits: SPECTRAFORCE offers ACA compliant health benefits as well as dental, vision, accident, critical illness, voluntary life, and hospital indemnity insurances to eligible employees. Additional benefits offered to eligible employees include commuter benefits, 401K plan with matching, and a referral bonus program. SPECTRAFORCE provides unpaid leave as well as paid sick leave when required by law.

Equal Opportunity Employer: SPECTRAFORCE is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, age, sexual orientation, gender identity, genetic information, disability or veteran status, or any other category protected by applicable federal, state, or local laws. Please contact Human Resources at LOA@spectraforce.com if you require reasonable accommodation.

California Applicant Notice: SPECTRAFORCE is committed to complying with the California Privacy Rights Act (“CPRA”) effective January 1, 2023; and all data privacy laws in the jurisdictions in which it recruits and hires employees. A Notice to California Job Applicants Regarding the Collection of Personal Information can be located on our website. Applicants with disabilities may access this notice in an alternative format by contacting NAHR@spectraforce.com .

LA County, CA Applicant Notice: If you are selected for this position with SPECTRAFORCE, your offer is contingent upon the satisfactory completion of several requirements, including but not limited to, a criminal background check. We consider qualified applicants with arrest or conviction records for employment in accordance with all local ordinances and state laws, including the Los Angeles County Fair Chance Ordinance for Employers (FCO) and the California Fair Chance Act (FCA). The background check assessment will consider whether a criminal history could reasonably have a direct, adverse impact on the job-related safety, security, trust, regulatory compliance, or suitability for this role. Such findings may result in withdrawal of a conditional job offer.
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