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.
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• Assist with Medical Record Retrieval for HEDIS and Risk Adjustment.
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• Participate in internal audits for Supplemental Data.
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• Support other needs within the Quality Department.

Requirements
• RN License required.
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• 3 years of clinical experience required.
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• 5 years of HEDIS and Overread experience required.
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• 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.
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• Remote work flexibility with a hybrid model.