USRN Team Leader (w/ joining bonus) - Cebu

The HEDIS Nurse Abstractor reviews the medical records and provides determination on compliance against HEDIS standards.

Duties and Responsibilities

The job holder will work with groups of Employees (EEs), and Functional Heads in addition to individuals across a variety of tasks:

· Performs HEDIS abstraction utilizing appropriate tools and resources as approved by the Director of the HEDIS Program· Gather and review all available medical records related to the chase· Verify correctness and completeness of data presented· Conduct investigation on utilization for additional data as necessary· Follows client provided protocol in reviewing, documenting, and completing the abstraction process· Follows all customer standards and adhere to all applicable CMS and NCQA rules and regulations including customer-provided timelines· Refers out-of-scope reviews to the customer HEDIS Coordinator· Works closely with management team in the ongoing development and implementation of the program.· Maintains confidentiality of all information, policies, and procedures as required by the Health Insurance Portability and Accountability Act (HIPAA) protocols· Maintains acceptable levels of performance including but not limited to attendance, adherence to protocols, customer courtesy, and all other productivity and efficiency targets and objectives· Reviews daily feedback and incorporate guidance to the daily practie· Learns new methods and services as the job requires· Advises supervisor of any potential problems as they become evident.· Manages assigned workload within established performance standards.· Attends meetings to achieve departmental goals and objectives.· Performs other duties as assigned or required.

III. Relationships

· Interpersonal CommunicationPartners with Functional Heads and EEs across the organization for a meaningful understanding of their requirements; and effective delivery of these.· Customer Service OrientationMaintains and advocates a cheerful and positive attitude, ensuring that a welcoming environment is established and consistently projected.· Relationship BuildingEstablishes relationships and networks across a broad range of people and groups, both internally and externally.· Developing PeopleWorks well with others towards achieving desired results, clarifies goals and roles and initiates clarification and conflict resolution

IV. Educational & Job Qualifications

· Must have a Bachelor’s degree in Nursing· Philippine based nurse will have active and unrestricted US and PH RN licenses to practice in both the Philippines and a US state.· US based nurse will have active and unrestricted US RN license to practice in a US state.· At least one (1) year of clinical experience preferred· Knowledge of nursing principles, techniques, and procedures for the care of patients· Knowledge of medical terminology, anatomy, physiology and concepts of disease· Makes sound clinical decisions in a timely manner· Skilled in providing effective nursing care, assessing patient situations and taking effective courses of action· Good critical and analytical thinking skills· Effectively meets strict deadlines· Detail oriented and possess good organization skills· Effective written and oral communication skills and be able to maintain confidentiality· Demonstrated PC knowledge including Windows, MS Applications - Microsoft Word, Excel, and Outlook· Minimum typing speed of 30 wpm with 5% errors or less· Able to work rotational shifts with adherence to schedule a must, including evenings, weekends and overtime as necessary· Willingness to render extended hour/s as the need arises· Knowledge of American culture