Nurse Reviewer
Lovelace Health Plan - Albuquerque, NM

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Nurse Reviewer-HEDIS

PRN - 3 month assignment

Lovelace Health Plan is part of the family of companies that make Lovelace Health System one of the leaders across New Mexico's health care system. When you work with Lovelace Health Plan, our goal is to improve quality care, and affordable accessible health care for New Mexicans. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and integrated Healthcare System. Lovelace Health Plan has an immediate opening as a PRN Nurse Reviewers - HEDIS.

The Nurse Reviewer is responsible for reviewing patient medical records to ensure documentation is within compliance with established regulatory agencies. In addition, reviews medical records to ensure appropriate patient billing. Prepares and maintains a variety of statistical reports and records. Adheres to policies, procedures and regulations to ensure compliance and patient safety.

Requirements:
Minimum: Bachelor’s of Science in Nursing. Education may be substituted for relevant nursing experience in accordance to policy.

PC skills with ability to analyze and interpret data; ability to organize workflow, function independently and manage own time and work tasks; strong interpersonal communication skills; ability to deal calmly, courteously and efficiently with people.

Two (2) years of previous job-related experience. Experience may be substituted for relevant education in accordance to policy.

Current RN license in State of New Mexico

Lovelace Health System consists of Lovelace Medical Center, Lovelace Rehabilitation Hospital, Lovelace Women’s Hospital, Lovelace Westside Hospital, Heart Hospital of New Mexico at Lovelace Medical Center, the Lovelace Health Plan offering health insurance to 240,000 New Mexicans with access to a wide range of health care providers and specialists across New Mexico, and 11 retail pharmacy locations in Albuquerque, Rio Rancho and Santa Fe.

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AHS Medical Holdings (doing business as Ardent Health Services) is passionate about healing the body. The company operates about 10 acute...