Jobs Home > Case Management > NJ - New Jersey (All) > Execu|Search > HEDIS Nurse


Execu|Search Type Contract Posted 11/26/2013
Salary $33-$35 per hour Starts 4/23/2014
NJ - New Jersey (All) - Trenton Referral - n/a -    
Location: Trenton, NJ
Salary: $33-$35 per hour
Experience: 0.0 year(s)
Job Type: Temporary / Consulting
Job ID: U977551

About the Opportunity

A licensed Registered Nurse (RN) or Licensed Practical Nurse (LPN), with aHEDISbackground, is currently being sought to fill an immediate need with a healthcare organization in New Jersey. In this role, theHEDISNurse will be responsible for performing RN duties using established guidelines to ensure appropriate level of care as well as planning for the transition to the continuum of care.

Company Description

Healthcare Organization

Job Description


  • Assesses patient's clinical need against established guidelines and/or standards to ensure that the level of care and length of stay of the patient are medically appropriate for inpatient stay
  • Evaluates the necessity, appropriateness and efficiency of medical services and procedures provided
  • Coordinates and assists in implementation of plan for members
  • Monitors and coordinates services rendered outside of the network, as well as outside the local area, and negotiate fees for such services as appropriate
  • Coordinates with patient, family, physician, hospital and other external customers with respect to the appropriateness of care from diagnosis to outcome
  • Coordinates the delivery of high quality, cost-effective care supported by clinical practice guidelines established by the plan addressing the entire continuum of care
  • Monitors patient's medical care activities, regardless of the site of service, and outcomes for appropriateness and effectiveness
  • Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services provided
  • Encourages member participation and compliance in the case/disease management program efforts
  • Documents accurately and comprehensively based on the standards of practice and current organization policies
  • Interacts and communicates with multidisciplinary teams either telephonically and/or in person striving for continuity and efficiency as the member is managed along the continuum of care
  • Evaluates care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomes.
  • Serves as mentor/trainer to new RN's and other staff as needed
Required Skills
  • 1+ year of priorHEDISexperience
  • RN orLPNlicense
  • BSN
  • Experience with Case Management,QARR, and Managed Care
  • Understands fiscal accountability and its impact on the utilization of resources, proceeding to self-care outcomes
  • Patient oriented
  • Excellent communication skills
  • Strong attention to detail
  • Highly organized