Maxim Staffing Solutions in Houston, TX is currently seeking experienced Registered Nurses (RN) in the area for a long-term contract working with local managed care company performing HEDIS review.
Assignment will training in December 2013 and run January thru May 2014.
Hours are Monday - Friday; 8am - 5pm. No weekends/Holidays.
Will Review most records on-line; minimal on-site reviews and only local.
Nurse must be research and detail oriented with the tenacity to find claim specific data for a specific measure within a given period of time.
Must have at least 6 months of experience working with HEDIS review.
Must have current RN/LVN license in the State of Texas of other Compact State.
Current CPR required.
Must have excellent computer skills and analysis capabilities.
Must be able to navigate CPT4 code and ICD9 DX based on HEDIS Technical Specification requirements. Candidates must have an understanding of codes for services based on diagnosis and procedure. type 30 - 40 WPM.
If you are interested and experienced in working this 6 month assignment for HEDIS review, please contact Lindsey Rogowicz at 281-968-9245 or send your resume to firstname.lastname@example.org
The HEDIS Program Manager will also be responsible for planning, developing, organizing, implementing and coordinating health plan activities related to the HEDIS process, QI interventions, related clinical performance measure, and other quality activities. The position will also be responsible for continually reviewing the need to improve data capture of member and provider information.
• Develop the annual HEDIS work plan and timeline in accordance with MHO and regulatory mandates.
• Coordinate the timely completion of the Baseline Assessment Tool (BAT).
• Provide coordination of the annual onsite HEDIS audit.
• Coordinate and provide supervision of the comprehensive aspects of the hybrid medical record review, in conjunction with the medical record vendor.
• Evaluate and analyze HEDIS rates.
• Participate in the HEDIS post mortem analysis and CQI process to increase rates.
• Respond to HEDIS audit Corrective Action Plan (CAP).
• Develop and maintain the HEDIS training manual.
• Monitor HEDIS project progress to identify system and other issues, troubleshoot and coordinate resolution with corporate MHI.
• Communicate project status to management, and convey information as appropriate to HEDIS Operations staff and other MHI counterparts.
• Interface with HEDIS Operations and IT department to identify data management inefficiencies to improve administrative rates.
• Verify that data are submitted to external agencies within required time frames.
• Provide exemplary customer service to “customers” who include members, co-workers, vendors, providers, regulatory agencies, business partners, and the general public.
• Assist and/or coordinate projects as directed by Director of Quality Improvement (e.g., status reports for Quality Committees oversight reporting.)
• Other duties as assigned
• Four year degree from an accredited college/university is preferred.
• At least four years HEDIS project experience preferred.
• Familiarity with NCQA Accreditation standards and regulatory agency requirements.
• Experience with Microsoft Office Suite and the ability to learn new information systems and software programs.
• Strong problem solving, project management and organizational skills with an ability to work in a fast paced environment.
• General knowledge of managed care delivery system.
• Excellent interpersonal skills, both verbal and written.
• Excellent analytical and management skills.
• Current Registered Nurse License for the state in which the nurse practices.
• Full command, verbal and written, of the English language.
• Current Health Certificate (if applicable).
• Current PPD or Chest X-Ray.
• One year prior professional nursing experience preferred.
• Current BLS card.
• Successful completion of screening tests for the clinical specialty area(s) in which the RN practices with a score of 80% or greater
• Maxim background screening
Maxim employees are our greatest asset. We offer the following benefits:
• Medical, Dental, Vision, and Life Insurance
• 401k Program
• Competitive Pay
• Flexible Scheduling
• Direct Deposit
• Positive Work Environment and Internal Bonuses
• Travel Benefits (as applicable)
• 24 hour on- call service
Since 1988, Maxim Healthcare Services has become one of the largest employers of clinicians in the nation. At Maxim Staffing Solutions, a division of Maxim Healthcare Services, we’re known for our quality of patient care, commitment to employee development and emphasis on customer service. Maxim knows that you deserve great benefits, flexible scheduling and rewarding assignments, so our Healthcare Recruiters will match your skills, experience and schedule in order to find you the best assignments in top medical facilities. Maxim Recruiters are always available to provide you with the assistance you need to get your job done, so call us today; Maxim has a solution for you.