Registered Nurse HEDIS Reviewer
Job Summary
To enhance healthcare outcomes and compliance, the full-time Remote Registered Nurse HEDIS Reviewer will perform clinical reviews of healthcare data, focusing on HEDIS measures and collaborating with cross-functional teams to support quality improvement initiatives.
Key responsibilities
- Conduct clinical chart reviews and audits to ensure compliance with HEDIS measures
- Develop reports to identify care gaps and collaborate with providers to ensure necessary services are documented
- Coordinate outreach efforts to collect clinical documentation from providers as per HEDIS specifications
Required qualifications
- Bachelor's degree in nursing required
- 5+ years of experience in healthcare, specifically in HEDIS and/or quality improvement
- Experience in a managed care health services environment
- Active and unrestricted Nursing license
- Knowledge of NCQA and HEDIS standards
COMPLETE JOB DESCRIPTION
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