New Mexico Licensed Review Nurse

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