CVS Health

Quality Management (RN) Registered Nurse Consultant HEDIS

Posted 7 days ago

Job Description

Job Description
Local travel is required.

Schedule is Monday-Friday standard business hours. No nights, no weekends and no holidays!

* Responsible for the review and evaluation of clinical information and documentation
* Reviews documentation and interprets data obtained from clinical records or systems to evaluate HEDIS requirements to include documentation as well as coding
* Coordinates and educates providers on specific HEDIS and other audit requirements
* Evaluates documentation/information to determine compliance with clinical policy, regulatory and accreditation guidelines, maximize HEDIS outcomes and compliance with Virginia Medicaid Waiver programs.
* Pro-actively and consistently applies HEDIS specifications, waiver program requirements and accreditation standards to assure that activities are processed within guidelines.
* Condenses complex information into a clear and precise clinical picture while working independently.
* Reports audit or clinical findings to appropriate staff or others in order to ensure appropriate outcome and/or follow-up for improvement as indicated.

Required Qualifications
* 3 years of clinical experience required
* HEDIS experience required
* Quality experience required
* Virginia resident required

LICENSE RN with current unrestricted state of Virginia licensure required

Preferred Qualifications
Managed Care experience preferred

Bachelor's degree or equivalent experience

Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.