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Martin's Point Health Care

We are people caring for people.

HEDIS Nurse Reviewer – New England Region

ReviewerGeneralFull TimeRemoteSeniorTeam 501-1,000H1B No SponsorCompany SiteLinkedIn

Location

Maine

Posted

6 days ago

Salary

0

Seniority

Senior

Bachelor Degree5 yrs expEnglish

Job Description

HEDIS Nurse Reviewer – New England Region

Martin's Point Health Care

• 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.

Job Requirements

  • 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

  • Health care coverage
  • Professional development opportunities
  • Annual training provided

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