HEDIS Medical Record Review Project Nurse
About The Position
This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law. The HEDIS Medical Record Review Project Nurse will be responsible for HEDIS medical record identification and abstraction throughout the year.
Requirements
- Requires a BS in nursing and minimum of 2 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
- Current, unrestricted clinical license appropriate to field of specialty (LPN/RN) as required
- Active state license required
Nice To Haves
- Minimum of 2 years of experience as a HEDIS medical chart reviewer preferred
Responsibilities
- Serves as a resource and subject matter expert on HEDIS quality reviewer processes
- Conducts over-reads on HEDIS records for compliance against HEDIS Technical Specifications
- Educates providers on HEDIS specifications and medical record documentation via various mediums such as HEDIS Encounter Portal Submission Tool, Hybrid Review Tool, HEDIS reference material development, and any other educational pieces for Provider relations, etc
- Provides feedback to providers via the HEDIS Encounter Submission Tool for medical records reviewed throughout the year
- Reviews HEDIS Encounter Portal submissions for Star Metrics throughout the calendar year with given set deadlines
- Works on projects as assigned
- Develops expertise in the requirements and parameters of mandated HEDIS performance measures on an annual basis
Benefits
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical
- dental
- vision
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
