Full Time

Call Center Nurse – Overnight Customer Service Jobs Remote

Posted 12 months ago

Texas

$40 - $42 per hour

Job Type: Call Center Nurse from home
Location: Texas work from home
Company: Adecco Group

Supervise and provide guidance to nurse clinical quality contractors.
Conduct medical record reviews for HEDIS and HEDIS-like measures.
Outreach to members to discuss preventive care and explain available plan services and benefits.
Verify clinical data elements for HEDIS reporting by reviewing assigned medical records (e.g., lab test results, hypertension verification, blood pressure readings, transitional care services).
Integrate data from various electronic and paper sources.
Demonstrate intermediate proficiency in Microsoft Office applications, especially Excel for managing data.
Identify findings supported by documentation guidelines accurately.
Maintain HIPAA standards and confidentiality, reporting critical incidents promptly.
Communicate pursuit leads for additional medical records to team members.
Attend conference calls related to clinical reviews and compliance.
Complete HEDIS technical specification and software training successfully.
Meet daily production goals.

Minimum of 3+ years of supervisory experience.
BSN from an accredited program with unrestricted licensure in any state.
Minimum 3 years of healthcare/health plan experience.
Minimum 3 years of HEDIS experience and/or knowledge.
Solid knowledge of managed care requirements related to clinical quality.
Research-oriented with strong attention to detail and proofreading skills.
Excellent time management and prioritization skills.
Designated workplace inside the home for virtual work.
Reliable internet connection for virtual work.
Strong communication skills.
Proficiency in Microsoft Office applications, including Word, Excel, Adobe, and PowerPoint.
Critical thinking skills.
Self-driven and results-oriented.