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HEDIS Nurse Reviewer – New England Region
Martin's Point Health CareNurse HEDIS Reviewer performing clinical reviews and audits ensuring compliance with HEDIS standards at Martin's Point Health Care. Collaborating with teams to enhance healthcare outcomes.
About the role
Key responsibilities & impact- Performs clinical chart reviews and audits to ensure accuracy and compliance with HEDIS measures.
- Develops reports to identify HEDIS care gaps and trends and works closely with providers to ensure the necessary services are provided and documented according to HEDIS requirements.
- Assists in the coordination of outreach efforts to request, collect, and secure clinical documentation from individual providers or provider groups as indicated by individual HEDIS measure specifications.
- Collaborates with health plan departments to identify HEDIS data sources and develop systems to capture this data in accordance with HEDIS technical specifications, such as supplemental databases.
- Collaborates with data analysts and quality teams to support performance improvement.
- Documents findings and recommends strategies to improve HEDIS measure performance.
- Applies clinical expertise to identify and validate data discrepancies.
- Educates non-clinical staff on HEDIS requirements and clinical relevance of data.
- Corresponds with members and clinical providers to effectively coordinate care, obtain medical records, and ensure patients receive preventive and chronic disease management services.
Requirements
What you’ll need- Bachelor’s degree in nursing required
- 5+ years of experience in the health care industry, in HEDIS and/or quality improvement
- Experience in managed care health services environment
- NCQA and HEDIS Experience
- Active and unrestricted Nursing license
Benefits
Comp & perks- Health care coverage
- Professional development opportunities
- Annual training provided
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Clinical Chart ReviewData AnalysisHEDIS Measure CompliancePerformance ImprovementClinical DocumentationData Discrepancy ValidationReport DevelopmentOutreach CoordinationCare CoordinationPreventive Care Management
Soft Skills
CollaborationCommunicationEducationProblem-SolvingInterpersonal Skills
Certifications
Active Nursing License