Remote HEDIS Nurse Reviewer & Quality Educator

Elevance Health; Tallahassee (FL); Remote; USD 55,000 - 75,000; Full time

Job summary

Elevance Health is seeking a HEDIS Medical Record Review Project Nurse to support HEDIS data collection and quality review. This is a virtual, full-time role with required in-person training sessions; candidates must reside in Florida and be able to travel for training if needed.

The position emphasizes accuracy, process adherence, and provider education. The ideal candidate has a nursing degree, an active state license, and at least two years of clinical or HEDIS chart review experience.

Qualifications

• Requires a BS in nursing and minimum of 2 years of clinical experience; or equivalent background.
• Active state nursing license required (RN or LPN).
• Minimum 2 years of experience as a HEDIS medical chart reviewer preferred.

Responsibilities

• Identify and abstract HEDIS medical records throughout the year.
• Serve as SME on HEDIS quality reviewer processes.
• Conduct over-reads on HEDIS records for compliance with specifications.
• Educate providers on HEDIS specs and documentation via multiple tools.
• Provide feedback to providers through submission tools.
• Review HEDIS Encounter Portal submissions for Star Metrics with deadlines.
• Develop expertise in mandated HEDIS performance measures annually.

Skills

HEDIS knowledge

RN license

LPN license

Clinical experience

Education

BS in Nursing

Job description

Elevance Health is seeking a HEDIS Medical Record Review Project Nurse to support HEDIS data collection and quality review. This is a virtual, full-time role with required in-person training sessions; candidates must reside in Florida and be able to travel for training if needed.

The position emphasizes accuracy, process adherence, and provider education. The ideal candidate has a nursing degree, an active state license, and at least two years of clinical or HEDIS chart review experience.