- Position will start in January***
- Description:* The HEDIS nurse will review patient charts and abstract data points based on Medicaid NCQA guidelines. The HEDIS nurse will toggle between 2 screens to enter patient health information into Electronic Medical Record (EMR) system. Additionally... -Supervise and facilitate successful interventions to meet behavioral health HEDIS and Pay for Performance measures.
Partner with health plans and regional clinical leadership to identify and implement interventions to increase HEDIS rates in behavioral health measures. -Develop and implement innovative strategies in collaboration with clinical staff to improve compliance with key behavioral health HEDIS metrics and Pay for Performance (P4P) Measures -Prepare and present financial impact and return on investment on initiatives requiring additional funding or resources -Act as a liasion with quality improvement, health plan medical management and other departments regarding current and planned interventions, collect input on how to impact these outcomes, and provide feedback to stakeholders on outcomes -Monitor the effectiveness for new and existing P4P and HEDIS initiatives and ensure appropriate knowledge/education and interventions are conducted for members falling into these measures -Analyze data to address trends or potential quality and clinical improvement opportunities based on best practices and feedback from involved stakeholders
- Skills:* HEDIS, Measures, Abstracting, Overreads, EMR, Quality, Audit, Chart abstraction, Medical, Medical record, Managed care
- Top Skills Details:* HEDIS,Measures,Abstracting,Overreads,EMR,Quality,Audit,Chart abstraction
- Additional Skills & Qualifications:* Bachelors degree in nursing, related field, or equivalent experience.
3+ years of experience in case and/or utilization management in a behavioral health or physical health care setting.
Knowledge of key behavioral or physical health related HEDIS & performance measures required with preferred experience in implementing new interventions to affect these rates.
Supervisory or lead experience preferred Attention to detail Ability to be independently productive HEDIS project experience Experience abstracting data from medical records Experience in QSHR FL (or South GA) resident License/Certificates:
Current states unrestricted license as a LCSW, LMFT, LPN, PhD, PsyD or RN preferred"
- Experience Level:* Intermediate Level
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