HEDIS Medical Review Nurse-I
About the position
The HEDIS Clinical Medical Review Nurse will play a crucial role in the Quality Team, primarily responsible for conducting HEDIS overreads in accordance with NCQA guidelines. This position requires a blend of clinical nursing experience and specialized knowledge in HEDIS processes, focusing on quality assurance and compliance within the healthcare system.
Responsibilities
ā¢ Conduct thorough HEDIS overreads in line with NCQA guidelines.
,
ā¢ Assist with Medical Record Retrieval for HEDIS and Risk Adjustment.
,
ā¢ Participate in internal audits for Supplemental Data.
,
ā¢ Support other needs within the Quality Department.
Requirements
ā¢ RN License required.
,
ā¢ 3 years of clinical experience required.
,
ā¢ 5 years of HEDIS and Overread experience required.
,
ā¢ In lieu of education, 10 years of recent HEDIS abstractions/overreads experience in the payer/health insurance side of HEDIS or with a HEDIS vendor.
Nice-to-haves
Benefits
ā¢ Competitive hourly pay ranging from $34 to $39 per hour.
,
ā¢ Remote work flexibility with a hybrid model.
Apply Now
Apply Now
The HEDIS Clinical Medical Review Nurse will play a crucial role in the Quality Team, primarily responsible for conducting HEDIS overreads in accordance with NCQA guidelines. This position requires a blend of clinical nursing experience and specialized knowledge in HEDIS processes, focusing on quality assurance and compliance within the healthcare system.
Responsibilities
ā¢ Conduct thorough HEDIS overreads in line with NCQA guidelines.
,
ā¢ Assist with Medical Record Retrieval for HEDIS and Risk Adjustment.
,
ā¢ Participate in internal audits for Supplemental Data.
,
ā¢ Support other needs within the Quality Department.
Requirements
ā¢ RN License required.
,
ā¢ 3 years of clinical experience required.
,
ā¢ 5 years of HEDIS and Overread experience required.
,
ā¢ In lieu of education, 10 years of recent HEDIS abstractions/overreads experience in the payer/health insurance side of HEDIS or with a HEDIS vendor.
Nice-to-haves
Benefits
ā¢ Competitive hourly pay ranging from $34 to $39 per hour.
,
ā¢ Remote work flexibility with a hybrid model.
Apply Now
Apply Now