HEDIS Nurse Reviewer (Temp) – Quality & Data Insight

Martin's Point Health Care Inc.; Portland, Northern (ME, KY); Hybride; USD 87 000 - 107 000; Plein temps

Résumé du poste

Martin's Point Health Care Inc. in Portland, ME seeks a HEDIS Nurse Reviewer to perform clinical record reviews and data extractions ensuring HEDIS compliance. You will analyze data, identify gaps, and support quality initiatives with providers and care teams.

The ideal candidate has 5+ years in health care, HEDIS/quality improvement, and NCQA experience, along with an unrestricted RN license and EMR proficiency. Join a mission-driven team focused on improving outcomes and reporting.

Qualifications

• Bachelor’s degree in nursing required.
• Active and unrestricted Nursing license.
• Certified Coder certification preferred.
• 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.

Responsabilités

• 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 works closely with providers to ensure the necessary services are provided and documented according to HEDIS requirements.
• Conducts analysis to identify patterns, root causes, and opportunities for process and performance improvement.
• Supports Health Plan Quality programs and reporting for regulatory requirements (CMS, DHA, NCQA, etc.).
• Prioritizes reports according to business needs, regulatory requirements, urgency, and other key business factors.
• Assists in the coordination of outreach efforts as needed to request, collect, and secure clinical documentation from individual providers or provider groups as indicated by individual HEDIS measure specifications.

Connaissances

EMR navigation

Microsoft Word

Microsoft Excel

Adobe Acrobat

Formation

Bachelor’s degree in nursing

Outils

EMR systems

Microsoft Word

Microsoft Excel

Adobe Acrobat

Description du poste

Martin's Point Health Care Inc. in Portland, ME seeks a HEDIS Nurse Reviewer to perform clinical record reviews and data extractions ensuring HEDIS compliance. You will analyze data, identify gaps, and support quality initiatives with providers and care teams.

The ideal candidate has 5+ years in health care, HEDIS/quality improvement, and NCQA experience, along with an unrestricted RN license and EMR proficiency. Join a mission-driven team focused on improving outcomes and reporting.