Contract HEDIS Nurse Reviewer for Quality Insights

Martin's Point Health Care Inc.; United States; Presencial; USD 87.000 - 107.000; Jornada completa

Descripción de la vacante

Martin's Point Health Care Inc. is seeking a HEDIS Nurse Reviewer to perform clinical record reviews and audits focused on HEDIS measures. The role requires nursing licensure, 5+ years in health care, and experience with NCQA/HEDIS standards.

Responsibility includes data extraction, reporting, and collaboration with providers to close care gaps. Strong EMR navigation and documentation discipline are essential for success.

Formación

• Bachelor’s degree in nursing required.
• Active and unrestricted Nursing license.
• 5+ years of experience in the health care industry, in HEDIS and/or quality improvement.
• Experience in managed care health services environment.
• NCQA and HEDIS Experience.
• Ability to navigate multiple EMR and health plan applications.
• Intermediate level of Microsoft Word, Excel and Adobe.

Responsabilidades

• Performs clinical record reviews, data validations, and overreads to ensure accuracy and compliance with HEDIS measures.
• Develops reports to identify HEDIS care gaps and trends and work with providers to ensure services documented per HEDIS requirements.
• Conducts analysis to identify patterns, root causes, and opportunities for improvement.
• Supports Health Plan Quality programs and regulatory reporting (CMS, DHA, NCQA).
• Prioritizes reports according to business needs and regulatory requirements.
• Assists in coordinating outreach to collect and secure clinical documentation.
• Identifies, collects, documents, and stores HEDIS data per SOPs and specifications.
• Applies clinical judgement to validate diagnoses and documentation elements.
• Educates non-clinical staff on HEDIS requirements and relevance.

Conocimientos

Attention to detail

Organizational skills

Communication

Educación

Bachelor’s degree in nursing

Herramientas

EMR systems

Microsoft Word

Microsoft Excel

Adobe Acrobat

Descripción del empleo

Martin's Point Health Care Inc. is seeking a HEDIS Nurse Reviewer to perform clinical record reviews and audits focused on HEDIS measures. The role requires nursing licensure, 5+ years in health care, and experience with NCQA/HEDIS standards.

Responsibility includes data extraction, reporting, and collaboration with providers to close care gaps. Strong EMR navigation and documentation discipline are essential for success.