Remote HEDIS Nurse: Medical Record Review Project

Elevance Health; Tampa (FL); Hybrid; USD 60,000 - 85,000; Full time

Job summary

Elevance Health is seeking a HEDIS Medical Record Review Project Nurse in Florida for a virtual, full-time role with required in-person training sessions. The position supports a Hybrid Workforce Strategy with occasional onsite training and potential relocation within commuting distance from an Elevance Health office.

The nurse will identify and abstract HEDIS records, educate providers on specifications, and ensure accuracy against HEDIS Technical Specifications throughout the year.

Qualifications

• Requires a BS in nursing and minimum of 2 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.

Responsibilities

• Serves as a resource and subject matter expert on HEDIS quality reviewer processes
• Conducts over-reads on HEDIS records for compliance against HEDIS Technical Specifications
• Educates providers on HEDIS specifications and medical record documentation via various mediums such as HEDIS Encounter Portal Submission Tool, Hybrid Review Tool, HEDIS reference material development, and any other educational pieces for Provider relations, etc
• Provides feedback to providers via the HEDIS Encounter Submission Tool for medical records reviewed throughout the year
• Reviews HEDIS Encounter Portal submissions for Star Metrics throughout the calendar year with given set deadlines
• Works on projects as assigned
• Develops expertise in the requirements and parameters of mandated HEDIS performance measures on an annual basis

Skills

HEDIS knowledge

Clinical experience

Attention to detail

Education

BS in nursing

Job description

Elevance Health is seeking a HEDIS Medical Record Review Project Nurse in Florida for a virtual, full-time role with required in-person training sessions. The position supports a Hybrid Workforce Strategy with occasional onsite training and potential relocation within commuting distance from an Elevance Health office.

The nurse will identify and abstract HEDIS records, educate providers on specifications, and ensure accuracy against HEDIS Technical Specifications throughout the year.