Maine Licensed HEDIS Nurse Reviewer
Job Summary
Responsible for performing clinical reviews of healthcare data, the full-time Maine Licensed HEDIS Nurse Reviewer will focus on HEDIS measures and quality improvement while working remotely to ensure compliance and enhance healthcare outcomes.
Key responsibilities
- Conduct clinical record reviews and data validations to ensure accuracy with HEDIS measures
- Develop reports to identify care gaps and collaborate with providers to ensure necessary services are documented
- Analyze data to identify patterns and opportunities for process improvement in quality programs
Required qualifications
- Bachelor's degree in nursing required
- Active and unrestricted Nursing license
- 5+ years of experience in the healthcare industry, specifically in HEDIS and quality improvement
- Experience in a managed care health services environment
- NCQA and HEDIS experience preferred
Complete Job Description
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