HEDIS Nurse - SCAN Temp

SCAN Health Plan; United States; Presencial; USD 50.000 - 75.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Remote work

Medical benefits

Paid sick time

401(k) retirement plan

Employee recognition

Descripción de la vacante

SCAN is seeking an HEDIS Nurse to review medical records for Quality Initiatives/NCQA reporting. The role involves outreach to members and providers to ensure complete data and adherence to NCQA guidelines, with a focus on medication adherence and specific screening procedures.

The position requires RN or LVN licensure, 2–3 years of related experience, and the ability to work remotely as part of a temporary engagement. Benefits include medical coverage and 401(k) options.

Formación

• Associate degree or technical equivalent; RN/LVN licensure required.
• 2–3 years of related healthcare experience.
• 0–1 years of leadership experience.

Responsabilidades

• Abstracts clinical data from medical records per NCQA guidelines and internal procedures.
• Communicates with members/providers regarding Quality Initiative projects.
• Documents all interactions with members in the designated project system.
• Retrieves missing data to complete records during the review process.
• Coordinates with HEDIS staff to update and track medical records for reporting.

Educación

Associate's Degree or equivalent experience or Technical Degree

Registered Nurse (RN) or Licensed Vocational Nurse (LVN) required

Descripción del empleo

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the “12 Angry Seniors.” Their mission continues to guide everything we do.

Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults.

Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity.

At SCAN, we believe scale should strengthen—not dilute—our mission. We are building the future of care for older adults, grounded in purpose, accountability, and respect for the people and communities we serve.

The Job

The HEDIS Nurse reviews medical records for Quality Initiatives/HEDIS® reporting. Conducts outreach to members and/or providers in coordination with departmental outreach campaigns to collect necessary data to ensure complete medical records and reporting information.

Will participate in many interdepartmental initiatives which requires phone discussions with members. The primary objective is to discuss medication adherence and specific procedures which members need to fill gaps in their care (i.e. Bone density testing, colorectal cancer screenings, etc.).

You Will

HEDIS Duties:

• Abstracts clinical data from medical records per NCQA guidelines and internal procedures.
• Works to improve quality of care by communicating with members and providers regarding various Quality Initiative projects. Enters findings into designated database.
• Accurately documents all interactions with members in a manner specified by the project manager.
• Identifies pursuit opportunities and works closely with pursuit assistants to retrieve medical records information.
• Evaluates information, from a clinical perspective, to best obtain needed information from members and/or providers to complete specific objectives within the project timeline.
• Pursues missing data to complete records review, throughout the review process.
• Follows project manager’s directives to meet specific objectives within the project timeframe.
• Coordinates with HEDIS® staff regarding the updating and tracking of medical records for reporting purposes.
• Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies

Outreach Nurse Duties

• On an as needed basis, supports projects and/or interventions within or across departments throughout the organization (i.e. HCS, Pharmacy, etc.).
• Accurately reviews medical records and abstracts pertinent information to fulfill specific requirements as directed by the project manager.

Other

• We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.
• Actively support the achievement of SCAN’s Vision and Goals.
• Other duties as assigned.

Your Qualifications

• Associate's Degree or equivalent experience or Technical Degree.
• Registered Nurse (RN) or Licensed Vocational Nurse (LVN) required.
• 2-3 years of related experience.
• 0-1 years of leadership experience .
• Knowledge of the field's policies, procedures, and practices. Leads and directs the work of other employees .
• Level I supervisors typically have little authority for personnel.

SCAN Temp

What's in it for you?

• This is a temporary opportunity for a limited period of time.
• Work Mode: Remote
• Medical Benefits
• Paid Sick Time
• Excellent 401(k) Retirement Saving Plan
• Robust employee recognition program
• An opportunity to become part of a team that makes a difference to our members and our community every day!

At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.

SCAN is proud to be an Equal Employment Opportunity and Affimative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)