CVS Health Quality Management (RN) Registered Nurse Consultan in Richmond, Virginia
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.
Local travel is required.
Schedule is Monday-Friday standard business hours. No nights, no weekends and no holidays!
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.
3 years of clinical experience required
Managed Care experience preferred
HEDIS experience required.
Quality experience required.
Virginia resident required.
RN with current unrestricted state of Virginia licensure required.
Additional Job Information
Typical office working environment with productivity and quality expectationsWork requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.Ability to multitask, prioritize and effectively adapt to a fast paced changing environmentPosition requires proficiency with computer skills which includes navigating multiple systems and keyboardingEffective communication skills, both verbal and written.
Bachelor's degree or equivalent experience
Percent of Travel Required
10 - 25%
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.
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