UPMC

Compensation

Full Description

UPMC Health Plan has an exciting opportunity for a HEDIS Coordinator position in the Quality Improvement department. This is a full time position working Monday through Friday daylight hours and will be a remote position. Must be located in Pittsburgh or surrounding area to be considered! Staff in this position are responsible for reviewing the clinical documentation submitted via the Novellus Care Gap Management Application and Biometric Application from network physicians and Health Plan staff, to support for HEDIS measure compliance or potential measure exclusion. Responsibilities: Adhere to the UPMC Health Plan HIPAA Compliance Guidelines. Ensure that HIPAA standards are met in all aspects of the Department functions including delegated functions. Ensure that all releases of member personal health information, which are conducted outside of the realm of Treatment, Payment, or Operations are appropriately logged. Performs in accordance with system-wide competencies/behaviors. Perform duties and responsibilities in accordance with the philosophy, standards and policies and procedures of the UPMC Health System, including conveying courtesy, respect, enthusiasm, and a positive attitude through all contacts with staff, health plan members, providers, peers, and visitors. Performs other duties as assigned. Conduct quality audits of clerical data entry tasks. Support annual HEDIS via chart abstraction and/or assistance with the over-read/auditing process. Assist with review of new HEDIS Specifications to identify measure criteria changes impacting medical record review outcomes. Assist with quarterly quality audits for reviews approved in the Novellus Care Gap Management Application and/or Biometric Application. Assist with updating/maintaining the HEDIS Measure Spreadsheet, to document review determinations for clinical documentation submitted for gap closure or measure exclusion. Review clinical documentation submitted by providers and Health Plan staff for potential HEDIS measure exclusion. Review and evaluate clinical documentation submitted by network providers and Health Plan staff through the Novellus Care Gap Management Application and/or Biometric Application for HEDIS measure compliance. Registered nurse, minimum of 5 years of health care related experience required, bachelor level preferred. Excellent verbal and written communication skills are required. Proficiency in Microsoft Word, PowerPoint, Excel, and Access preferred. Working knowledge of the National Committee on Quality Assurance (NCQA) HEDIS requirements preferred. Licensure, Certifications, and Clearances: Registered Nurse (RN) *Current licensure either in the state where the facility is located or, if the facility is in a state covered by the multistate Nursing Licensure Compact (NLC) agreement, a multistate license issued by a participating NLC state. Hires and current employees working on an out-of-state NLC license who later change their residency to the state where the facility is also located will have 60 days upon changing their residency to apply for licensure within that state. UPMC is an Equal Opportunity Employer/Disability/Veteran