HEDIS Nurse Auditor, Quality & Data

martin; Portland (ME); On-site; USD 87,000 - 107,000; Full time

Benefits offered by this job

Equal opportunity employer

Job summary

Martin's Point Health Care in Portland, Maine is seeking a HEDIS Nurse Reviewer. The role involves performing clinical record reviews to ensure HEDIS data accuracy and adherence to standards, and collaborating with providers to close care gaps.

The ideal candidate holds a Bachelor’s in nursing, an active RN license, and 5+ years in health care with HEDIS/quality improvement experience. NCQA/HEDIS familiarity is a plus, with a focus on data quality and regulatory support.

Qualifications

• Bachelor's degree in nursing is required.
• 5+ years in healthcare with HEDIS/quality improvement experience.
• Experience in managed care health services environment.
• NCQA and HEDIS experience preferred.

Responsibilities

• Performs clinical record reviews and data validations for HEDIS.
• Develops reports to identify HEDIS gaps and works with providers to document care.
• Identifies patterns and opportunities for process improvement.
• Supports Health Plan Quality programs and regulatory reporting.

Skills

EMR systems

Health plan apps

MS Word

Excel

Adobe

Education

Bachelor's degree in nursing

Job description

Martin's Point Health Care in Portland, Maine is seeking a HEDIS Nurse Reviewer. The role involves performing clinical record reviews to ensure HEDIS data accuracy and adherence to standards, and collaborating with providers to close care gaps.

The ideal candidate holds a Bachelor’s in nursing, an active RN license, and 5+ years in health care with HEDIS/quality improvement experience. NCQA/HEDIS familiarity is a plus, with a focus on data quality and regulatory support.