Molina Healthcare
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Molina's Quality Improvement Sr. Overreader conducts oversight and audits of the data collected and abstracted from medical records for HEDIS projects, HEDIS like projects and supplemental data collection. The overreader team will meet chart overread productivity standards, minimum over read standards, and 2nd overread standards to ensure accuracy of their audit skills. Sr. Overread team members will mentor new overread team members and assist with ad hoc projects.
REQUIRED EDUCATION: Bachelor's degree or equivalent experience REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES: 5 years experience in healthcare Quality/HEDIS specific to abstraction and overreading. PREFERRED EXPERIENCE: At least 3 years of medical record abstraction experience and at least 2 years experience in the overread role. 3+ years managed care experience. Advanced knowledge of HEDIS and NCQA. PREFERRED LICENSE, CERTIFICATION, ASSOCIATION: Active RN license for the State(s) of employment
Performs the role of the HEDIS medical record review overreader/auditor which includes ongoing review of records reviewed and data entered by the abstraction team during the annual HEDIS medical record review as well as all other HEDIS/HEDIS like project. Mentors entry-level Overreaders throughout the process. Provides feedback to providers on visit notes or feedback from the HEDIS audit. Makes recommendations based off of the audit and chart review. Assists with ad hoc projects. Participates in scheduled meetings with the Abstraction team, National Training Team, Regional HEDIS team, vendors and HEDIS auditors regarding quality and HEDIS review and results.
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