Registered Nurse Auditor

Intermountain Health • Nashville, TN • 3d ago

Job Description:

To review medical records retrieved from provider offices and abstract medical information for HEDIS (Health Effectiveness Data Information Set) annual audits. Interprets relevant clinical criteria through review of medical records annotates via Adobe PDF and populates a data collection tool to support compliance with HEDIS, CMS, and STARS performance measures.

Job Essentials

Work collaboratively with Select Health's HEDIS Manager, Quality Consultants, and Data Analyst

Responsible for performing accurate and comprehensive medical record reviews using a proprietary abstraction tool and software on an assigned laptop

Reviewer will perform remote or offsite medical record reviews with charts collected from provider offices, clinics and hospitals for the purpose of obtaining documentation to support the HEDIS project. Records will be retrieved by third party vendor, fax, remote EMR access and/or mail processes

Locate and review all assigned medical charts, perform abstraction, mark-up supporting documentation per audit specifications

Proven organizational and time management skills including the ability to meet required deadlines. Work with provider offices as needed to schedule/confirm appointments, and follow up on medical record requests

Calls members to gather procedural information on when and where the member received are and verify care was received.

Reviewer must pass a medical record abstraction test prior to beginning the project and will need to maintain minimum competency throughout the project

Frequent interactions with providers, members that require employee to verbally communicate as well as hear and understand spoken information, needs, and issues accurately

Minimum Qualifications

Current RN license in state of practice.

Current driver's license and access to personal vehicle to be able to travel to multiple local offices.

Three years of clinical experience in hospital, and/or physician office.

Computer skill in word processing and spreadsheets.

RNs with less than 12 months of working experience as an RN prior to joining Intermountain must obtain their BSN within five years of their start date.

Preferred Qualifications

Bachelor's Degree in Nursing (BSN) from an accredited institution.

Effective organizational skills and written and verbal communication skills.

Physical Requirements:

Ongoing need for employee to see and read information, assess member needs, and view computer monitors.

and -

Frequent interactions with providers, members that require employee to verbally communicate as well as hear and understand spoken information, needs, and issues accurately

and -

Manual dexterity of hands and fingers, this includes frequent computer use and typing for documenting member care, accessing needed information, etc.

Location:

SelectHealth - Murray

Work City:

Murray

Work State:

Utah

Scheduled Weekly Hours:

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

$34.53 - $52.25

We care about your well-being - mind, body, and spirit - which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits package here (https://intermountainhealthcare.org/careers/benefits) .

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

At Intermountain Health, we use the artificial intelligence ("AI") platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, all final decisions are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process.

All positions subject to close without notice.

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