HEDIS Registered Nurse or LPNs (Field Nurses - Hybrid)

A client of Insight Globals is looking for HEDIS RNs or LPNs for a partially remote contract position in PA and NJ. PARTIALLY remote position as it may require onsite reviews at provider offices based on needs of the area. Schedule is flexible. Remote aspects include contacting/scheduling provider onsite reviews, requesting records from providers via fax, abstraction & entry of medical records assigned by a Clinical Quality Lead nurse. Miles will be reimbursed for any travel. Computer equipment, encrypted zip drives and mobile phones are provided for uploading, transferring and scanning files to our secure file transfer site. 2 weeks of virtual training will be provided and required.

RESPONSIBILITIES will include (but not limited to):
Contacting/scheduling provider offices & traveling to onsite medical record reviews (mileage, tolls, parking reimbursed)
Communicate effectively and professionally with office managers, health systems and any other facility or care providers
Scan/Upload/Download medical records from onsite reviews daily
Medical record abstraction into database from onsite visit, assigned remote charts
Highlighting member demographics & HEDIS evidence using Adobe Acrobat Reader
Reviewing Overreads for any corrections and addressing each daily
Abide by all Code of Conduct, HIPAA, and patient confidentiality requirements
Attend & successfully complete remote training for first two weeks of project. Training includes attending HEDIS measure training via MS TEAMS, testing for proficiency, computer-based company training. Training is paid.

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com .

To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/ .

Required Skills & Experience

Active RN License or Active LPN License
2-3 years of clinical experience (Utilization management or utilization review)
Strong computer skills
Ability to occasionally travel to local providers

Nice to Have Skills & Experience

Previous HEDIS review experience or experience with Utilization Review, Quality, Medical Record auditing
Bachelors Degree

Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.