HEDIS Medical Review Nurse-I
About the position
The HEDIS Clinical Medical Review Nurse will play a crucial role in the Quality Team, primarily responsible for conducting HEDIS overreads in accordance with NCQA guidelines. This position requires a blend of clinical nursing experience and specialized knowledge in HEDIS processes, focusing on quality assurance and compliance within the healthcare system.
- Responsibilities
- Conduct thorough HEDIS overreads in line with NCQA guidelines. ,
- Assist with Medical Record Retrieval for HEDIS and Risk Adjustment. ,
- Participate in internal audits for Supplemental Data. ,
- Support other needs within the Quality Department.
- Requirements
- RN License required. ,
- 3 years of clinical experience required. ,
- 5 years of HEDIS and Overread experience required. ,
- In lieu of education, 10 years of recent HEDIS abstractions/overreads experience in the payer/health insurance side of HEDIS or with a HEDIS vendor.
Nice-to-haves
- Benefits
- Competitive hourly pay ranging from $34 to $39 per hour. ,
- Remote work flexibility with a hybrid model.
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