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 • Conduct thorough HEDIS overreads in line with NCQA guidelines. , • Assist with Medical Record Retrieval for HEDIS and Risk Adjustment. , • Participate in internal audits for Supplemental Data. , • Support other needs within the Quality Department. Requirements • RN License required. , • 3 years of clinical experience required. , • 5 years of HEDIS and Overread experience required. , • 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 • Competitive hourly pay ranging from $34 to $39 per hour. , • Remote work flexibility with a hybrid model. Apply Job! Apply to this Job