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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in reviewing medical records for Quality Initiatives and HEDIS® reporting, with a strong focus on data abstraction and communication with members and providers. Holds a Registered Nurse (RN) or Licensed Vocational Nurse (LVN) certification, ensuring compliance with NCQA guidelines and project objectives.
Highest-signal resume keywords
Quality Initiatives ReportingData AbstractionRegistered Nurse (RN)HEDIS® CoordinationClinical Data Evaluation
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Medical Record ReviewData CollectionMedication Adherence DiscussionCare Gap IdentificationClinical Information EvaluationNCQA Guidelines ComplianceProject Management SupportDocumentation AccuracyOutreach CoordinationQuality Initiative Communication
Soft Skills
CollaborationCuriosityCommunicationLeadershipProfessionalism
Tools & Technologies
Designated DatabaseEducational WorkshopsProfessional PublicationsPersonal NetworksProfessional Societies
Certifications & Qualifications
Registered Nurse (RN)Licensed Vocational Nurse (LVN)Associate's DegreeTechnical Degree
Industry Keywords
HEDIS®NCQAQuality InitiativesClinical DataHealthcare Standards
About the role
Key responsibilities & impact- Review medical records for Quality Initiatives/HEDIS® reporting.
- Conduct outreach to members and/or providers to collect necessary data and ensure complete medical records and reporting information.
- Discuss medication adherence and procedures needed to fill care gaps, including bone density testing and colorectal cancer screenings.
- Abstract clinical data from medical records per NCQA guidelines and internal procedures.
- Communicate with members and providers regarding Quality Initiative projects and enter findings into the designated database.
- Accurately document all member interactions as specified by the project manager.
- Identify pursuit opportunities and collaborate with pursuit assistants to retrieve medical record information.
- Evaluate clinical information to obtain needed data from members and/or providers within project timelines.
- Pursue missing data throughout the records review process.
- Follow project manager directives to meet project objectives and timelines.
- Coordinate with HEDIS® staff to update and track medical records for reporting.
- Maintain professional and technical knowledge through educational workshops, professional publications, personal networks, and professional societies.
- Support projects and interventions within or across departments as needed, including HCS and Pharmacy.
- Review medical records and abstract pertinent information as directed by the project manager.
- Actively support SCAN’s Vision and Goals.
- Perform other duties as assigned.
Requirements
What you’ll need- Associate's Degree or equivalent experience or Technical Degree.
- Registered Nurse (RN) or Licensed Vocational Nurse (LVN) required.
- 2-3 years of related experience.
- 0-1 years of leadership experience.
- Knowledge of the field's policies, procedures, and practices.
- Leads and directs the work of other employees.
- Level I supervisors typically have little authority for personnel.
- A background check is required.
- Curiosity about AI and its power to transform how we operate and serve our members.
Benefits
Comp & perks- This is a temporary opportunity for a limited period of time
- Medical Benefits
- Paid Sick Time
- Excellent 401(k) Retirement Saving Plan
- Robust employee recognition program
- An opportunity to become part of a team that makes a difference to our members and our community every day!