California Licensed HEDIS Nurse
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Job Summary
To support the Healthcare Informatics 5-Star/HEDIS team, the remote contract California Licensed HEDIS Nurse will engage with health plan members and provider offices to obtain clinical information, support quality initiatives, and improve Medicare Star Ratings and HEDIS performance measures.
Key Responsibilities
- Contact health plan members to discuss and coordinate required clinical screenings and preventive care measures
- Utilize NCQA HEDIS Technical Specifications to assess compliance and identify care gaps
- Accurately document member interactions and outcomes within HEDIS/5-Star database systems
Required Qualifications
- Active California Registered Nurse (RN) or Licensed Vocational Nurse (LVN) license required
- High School Diploma or equivalent required
- Minimum of 1 year of HEDIS and Medicare Quality Measures experience required
- Strong understanding of NCQA HEDIS Technical Specifications and Medicare quality programs
- Experience working with medical records abstraction, chart review, or quality improvement initiatives preferred
Complete Job Description
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