HEDIS RN - HYBRID

Sierra Solutions; New York (NY); Hybrid; USD 70,000 - 90,000; Full time

Job summary

Sierra Solutions is seeking a dedicated Registered Nurse to contribute to HEDIS data review initiatives. The role focuses on reviewing medical records, validating clinical information, and supporting timely quality reporting while upholding HIPAA standards.

The position offers a balanced schedule of in-office and remote work in a fast-paced healthcare environment. You will collaborate with clinical teams, navigate EMR systems like ECW, and strive for accuracy and productivity in every task.

Qualifications

• Must be a Registered Nurse (ASN or BSN) with at least 1 year of HEDIS review experience.
• Ability to work independently in a fast-paced, high-volume environment.
• Proficient with navigating multiple EMR systems, e.g., E Clinical Works (ECW).
• Experience with HEDIS measures such as BCS-E, COL-E, and EED is highly preferred.
• Demonstrated confidentiality and HIPAA compliance.

Responsibilities

• Review medical records to identify and validate clinical information for HEDIS quality measures.
• Perform clinical chart reviews and data abstraction with accurate documentation.
• Identify gaps in clinical documentation and assist with follow-up to obtain missing data.
• Navigate EMR systems and health plan portals to locate required clinical data.
• Support HEDIS data collection, quality measurement, and reporting deadlines.
• Coordinate with clinical quality teams, providers, and stakeholders as needed.
• Maintain HIPAA compliance and protect member confidentiality.
• Meet productivity, accuracy, and turnaround-time expectations.

Skills

Detail-oriented

Independently able to work

Healthcare data review

HIPAA confidentiality

Education

ASN or BSN RN

Tools

ECW (EClinicalWorks)

Job description

Summary

We are seeking a dedicated and detail-oriented professional to contribute to Healthcare Effectiveness Data and Information Set (HEDIS) initiatives. This role is pivotal in ensuring the accuracy and compliance of clinical data for HEDIS reporting, regulatory submissions, and quality improvement projects. With a balanced schedule of in-office and remote work, you'll have the flexibility to thrive in a fast-paced environment.

Responsibilities

• Review medical records to identify and validate clinical information relevant to HEDIS quality measures.
• Conduct clinical chart reviews, perform data abstraction, and ensure accurate documentation in designated systems.
• Identify gaps in clinical documentation and support follow-up efforts to obtain missing information.
• Navigate electronic medical records, provider records, and health plan systems to locate required clinical data.
• Support HEDIS data collection, quality measurement, and reporting deadlines.
• Coordinate with clinical quality teams, providers, and internal stakeholders as needed.
• Maintain compliance with HIPAA, member confidentiality requirements, and established quality standards.
• Meet productivity, accuracy, and turnaround-time expectations.

Qualifications

• Registered Nurse (ASN or BSN required) - LPNs will not be considered.
• Minimum of 1 year of HEDIS review experience.
• Ability to work independently and effectively in a fast-paced, high-volume environment.
• Tech-savvy with proficiency in navigating multiple EMR systems such as E Clinical Works (ECW).
• Experience with HEDIS Measures such as BCS-E, COL-E, and EED is highly preferred.
• Skilled at maintaining discretion and confidentiality while handling sensitive information.