Quality HEDIS-STAR Nurse - JHP

jeffersonhealth

Philadelphia (Philadelphia County)

On-site

USD 80,000 - 100,000

Full time

3 days ago

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Job summary

Health Partners Plans in Philadelphia seeks an STAR-HEDIS Quality Nurse to support quality initiatives by abstracting medical records for HEDIS, CMS STAR measures, PCMH, and P4P programs.

The role requires experience navigating multiple EMR systems, conducting detailed reviews, and collaborating with providers to obtain complete records for quality measurement and audits.

Qualifications

3 years quality management, HEDIS abstraction, and medical record review.
Advanced proficiency with EMR systems and abstracting data.
Knowledge of HEDIS and CMS STAR measures; interpret spec and standards.
Strong written and verbal communication; team and provider interaction.

Responsibilities

Obtain, review, and abstract medical records to close care gaps for HEDIS/STAR/PCMH/P4P.
Collaborate with Quality Management and provider offices for records collection.
Perform electronic retrieval, outreach, and onsite record collection.
Ensure documentation is complete, accurate, and compliant for audits.

Skills

EMR navigation

HEDIS knowledge

Attention to detail

Data abstraction

Time management

Communication

Remote work capability

Travel to provider offices

MS Office (Outlook, Word, Excel)

Education

Associate's Degree RN (PA) or multi-state RN license

LPN license (PA)

Bachelor's Degree

Driver's License (PA)

Tools

EMR systems

Job description

Number of Positions In Requisition 1

Job Details

The STAR-HEDIS Quality Nurse supports Quality Management initiatives by obtaining, reviewing, and abstracting medical record documentation to close care gaps for HEDIS, CMS STAR Ratings, , Patient-Centered Medical Home (PCMH), and Pay-for-Performance (P4P) measures. This role requires advanced experience navigating multiple electronic medical record systems, performing detailed medical record reviews, and accurately abstracting clinical data into quality and care management systems.

The nurse functions as an integral member of the Quality Management team, working collaboratively with colleagues and participating provider offices to obtain medical records. This includes electronic retrieval, manual provider outreach, and onsite record collection to support complete and compliant documentation for quality measurement and audits.

Job Description

Education - Required

Associate's Degree Unencumbered Registered Nurse (RN) license in Pennsylvania, or a multistate RN license through the Nurse Licensure Compact (NLC) or
Technical School Diploma Unencumbered Licensed Practical Nurse (LPN) in the Commonwealth of Pennsylvania

Education - Preferred

Bachelor's Degree

Experience - Required

3 years Quality management, HEDIS abstraction, clinical audit, or managed care Medical record review and abstraction Demonstrated experience navigating multiple EMR systems Prior HEDIS abstraction or chart review experience strongly preferred

Knowledge, Skills and Abilities - Required

Advanced proficiency navigating electronic medical record (EMR) systems and reviewing clinical documentation
Working knowledge of HEDIS and CMS STAR quality measures and the ability to interpret technical specifications and standards
Demonstrated attention to detail, data accuracy, and analytical thinking when abstracting and documenting medical record information
Effective time management and organizational skills, with the ability to manage shifting priorities and high-volume workloads during HEDIS season
Strong written and verbal communication skills, including professional interaction with internal teams and participating provider offices
Ability to work independently with minimal supervision in a remote environment while meeting quality, productivity, and compliance standards
Proficiency with Microsoft Office applications (Outlook, Word, Excel), Microsoft Teams, and related documentation tools
Commitment to maintaining confidentiality, professionalism, and customer service excellence
Valid drivers' license, dependable vehicle, and active auto insurance
Ability to travel locally to provider offices as needed
Ability to perform moderate physical activity, including walking and lifting/carrying up to 10 pounds

Knowledge, Skills and Abilities - Preferred

Prior experience with HEDIS abstraction, medical record review, or clinical quality reporting in a health plan, vendor, or provider setting
Flexibility and adaptability with new systems, workflows, and process changes

Licenses and Certifications - Required

DL - Driver's License_PA - State of Pennsylvania and
RN - Licensed Registered Nurse_PA - State of Pennsylvania or
LPN - Licensed Practical Nurse_PA - State of Pennsylvania

Additional Qualifications

Compliance Statement: Employees must comply with all applicable federal, state, and regulatory requirements related to Medicare Advantage and quality measurement. Completion of required compliance and quality training is a condition of employment

Access To Protected Health Information: QM, Care Management System, Medical Record Repository System, Salesforce, Natural Language Processing systems, etc.

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Health Partners Plans, Inc. Primary Location Address 1101 Market, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 pe

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