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Job Information

Aetna Quality Management (RN) Registered Nurse Consultant HEDIS in Richmond, Virginia

Req ID: 66782BR

Job Description

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. Requires an RN with unrestricted active license.

Fundamental Components included but are not limited to:

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.

Qualifications Requirements and Preferences:

3 years of clinical experience required

HEDIS experience required

Quality experience required

Managed Care experience preferred

RN with current unrestricted state licensure required.

Licenses/Certifications:

Nursing - Registered Nurse

Functional Skills:

Quality Management - Quality Management

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.

Benefit Eligibility

Benefit eligibility may vary by position.

Job Function: Healthcare

Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.

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