New Mexico Licensed Review Nurse
Job Summary
To support quality assurance initiatives, the part-time New Mexico Licensed Review Nurse will conduct annual patient chart audits to ensure provider compliance with insurance standards while working remotely on a contract basis.
Key responsibilities
- Apply structured auditing criteria to abstract medical records and enter results into the health plan's database
- Abstract medical record documentation for HEDIS measures used in annual reporting to the National Committee for Quality Assurance (NCQA)
- Maintain productivity with less than a 5% error rate in record abstraction and data entry
Required qualifications
- Unrestricted Registered Nurse (RN) license in New Mexico
- Clinical experience in utilization review or quality assurance
- Experience with medical record and site review audits
- Knowledge of medical terminology and federal/state accreditation regulations
- Proficiency in PC applications, including Word and Excel
Complete Job Description
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