HEDIS Nurse Job Description
HEDIS nurse
provides assistance to the Clinical Measurement and Improvement team in delivering necessary program documents, operations, and improvements for relevant accreditation, transparency, community collaboratives, and HEDIS reporting requirements. Provides feedback on EMR / EHR systems where it is causing issues in meeting CMS standards of documentation and coding.
HEDIS Nurse Duties & Responsibilities
To write an effective HEDIS nurse job description, begin by listing detailed duties, responsibilities and expectations. We have included HEDIS nurse job description templates that you can modify and use.
Sample responsibilities for this position include:
Collect member records and conduct reviews of these records as per NCQA HEDIS specifications
Audit/review case manager and provider clinical documentation and telephone interactions against regulations, accreditation standards and contract requirements
Review provider treatment records against clinical and procedural established standards
Conduct ongoing activities which monitor established quality of care standards in the participating provider network and for care managers
Collect, analyze and prepare clinical record information for projects related to assessing the efficiency, effectiveness and quality of the delivery of managed care services
Present findings at provider and customer meetings as needed
Assist in the planning and implementation of activities to improve delivery of services and quality of care including the development and coordination of in-service education programs for providers and care managers
Be responsible for auditing validating internal audit results and/or corrective action plans
Reviewing required data analysis and research within the the company's data systems
Be onsite 100% 4 days per week
HEDIS Nurse Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for HEDIS Nurse
List any licenses or certifications required by the position: RHIA, RHIT, CPC, CCS
Education for HEDIS Nurse
Typically a job would require a certain level of education.
Employers hiring for the HEDIS nurse job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Associate Degree in Nursing, Graduate, Education, Associates, Healthcare, Healthcare Administration, Science, Health Administration, Health, Public Health
Skills for HEDIS Nurse
Desired skills for HEDIS nurse include:
Windows and Microsoft Office
HIPAA rules and regulations
Microsoft Office
Specifically Excel
Managed care requirements related to clinical quality
Federal and state regulations / requirements
Different EMR systems
EMR / EHR and medical records
EMR systems and standard Windows applications
Desired experience for HEDIS nurse includes:
Travel to physician offices as needed
Communicate as much as possible via phone and fax
Adhere to measured productivity requirements, module testing and at times re-testing to meet minimum requirements
Perform research on internal claims systems
Develop and share strategies to accomplish goals
Work under the supervision of the managed care company's internal staff and designated lead in order to achieve goals and keep the project moving
HEDIS Nurse Examples
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HEDIS Nurse Job Description
Job Description Example
Our company is searching for experienced candidates for the position of HEDIS nurse. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for HEDIS nurse
- Work with the HEDIS team to collect member records and conduct reviews of these records
- Work under the supervision of internal staff
- Review data analysis and research within the company's systems
- Participate in collection and review of annual HEDIS data
- Participate in required audits to meet all accreditation and regulatory requirements
- Conduct Medical Record Review and coordination of continuity of care studies
- Review and investigate quality of care issues following prescribed guidelines and implementation of appropriate / timely actions
- *This opportunity will last thru May and has flexibility with hours anywhere from 25 - 40 hours weekly with the possibility of additional hours on an as need basis throughout the year.**
- Attend yearly HEDIS training
- Perform all HEDIS task in a timely manner and maintain output standards
Qualifications for HEDIS nurse
- Travel to provider sites when needed
- Upload medical records to secure FTP
- Perform correct and concise HEDIS abstraction
- Adhere to measured productivity requirements, module testing and re-testing
- Review required data analysis and research within the the company's data systems
- Interact with vendors, auditors, and enterprise-wide internal departments r
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HEDIS Nurse Job Description
Job Description Example
Our innovative and growing company is searching for experienced candidates for the position of HEDIS nurse. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for HEDIS nurse
- Manage data capture and integrity and ensure data from internal/external data sources incorporated into HEDIS/QARR/Stars
- Identify data improvement opportunities through QA of HEDIS/QARR/Star reports and data outputs and detecting data acquisition, capture, and system error issues
- Manage necessary changes for operational processing, data flow, collection and distribution to positively impact HEDIS/QARR/Star results
- Proactively explore, seek, and apply existing and new internal and external data sources and various methods
- Analyze plan's structured and unstructured data across different systems and platforms through various data manipulation, cleaning, and merging techniques
- Assist in the management of implementing corrective actions and re-evaluates impact based on actions taken
- Conduct evaluation studies and root-cause analyses to identify improvement area(s) and understanding of the marketplace
- Performing over-reads on HEDIS records
- Reviewing and abstracting paper and electronic medical records utilizing NCQA HEDIS Technical specifications to optimize Plan HEDIS scores
- Performing complete and accurate data entry of qualifying services and results into HEDIS electronic database software
Qualifications for HEDIS nurse
- Identifying and communicating patterns of missing documentation for the assessment of additional records
- Routing all exclusions and complex issues to the Quality Improvement Nurse
- Meeting or exceeding accuracy standard of 95% and turn around standard of 24-48 hours for medical record review and data entry
- Attending department meetings and delivering hard copy records weekly
- Successfully completing Medical Record Reviewer training and Inter Rater Reliability Testing at 100 percent
- Successfully completing HEDIS software training and using software correctly to facilitate accurate reporting and ongoing progress of the annual HEDIS project
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HEDIS Nurse Job Description
Job Description Example
Our innovative and growing company is looking for a HEDIS nurse. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for HEDIS nurse
- Conducting research in a thoughtful and methodical search in order to locate specific claim information, including all resources provided in order to find best information
- Review and abstract paper and electronic medical records utilizing NCQA HEDIS Technical specifications to optimize Plan HEDIS scores
- Perform complete and accurate data entry of qualifying services and results into HEDIS electronic database software
- Identify and communicate patterns of missing documentation for the assessment of additional records
- Route all exclusions and complex issues to the Quality Improvement Nurse
- Meet or exceed accuracy standard of 95% and turn around standard of 24-48 hours for medical record review and data entry
- Attend department meetings and delivers hard copy records weekly
- Successfully complete Medical Record Reviewer training and Inter Rater Reliability Testing at 100%
- Successfully complete HEDIS software training and uses software correctly to facilitate accurate reporting and ongoing progress of the annual HEDIS project
- Identify, develop and implement HEDIS® and QRS data collection and process improvement initiatives
Qualifications for HEDIS nurse
- Bachelor’s Degree in Nursing or Certification as Registered Health Information Administrator or Registered Health Information Technologist
- 1+ year of experience in Medical Record Review, Data Abstraction, Quality Management, GPRO or HEDIS
- Serves as a Project Lead by managing HEDIS® temporary staff and/or individuals assigned to the project, and effectively engaging with Health Care Professional offices and vendors to successfully complete project within organizational timeframes
- Serves as an active and engaged participant and/or lead on HEDIS® and quality-related project teams to improve workflows and continue to drive for operational efficiencies and excellence
- Develop, revise, and document policies, standard operating procedures, and workflows
- Assist Health Management Measurement and Improvement team in delivering necessary program documents, operations, and improvements for relevant accreditation, transparency, community collaboratives, and HEDIS® reporting requirements
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HEDIS Nurse Job Description
Job Description Example
Our growing company is looking to fill the role of HEDIS nurse. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for HEDIS nurse
- Serves as a Project Lead by managing HEDIS® temporary staff and/or individuals assigned to the project, and effectively engaging with Provider offices and vendors to successfully complete project within organizational timeframes
- Serves as an active and engaged market lead on HEDIS® and quality-related project teams to improve workflows and continue to drive for operational efficiencies and excellence
- Engage in relationship building with CAC groups and related matrix partners
- Reviews medical records and abstracts data for HEDIS measures and other medical record review (MRR) projects with minimum 95% accuracy and high productivity
- Registered Nurse (RN) will work as a Quality Improvement Nurse in a day-time, Monday through Friday, 40 hours/week position
- Registered Nurse (RN) will conduct studies and analyze data to evaluate the performance of health plan in key clinical preventive and chronic care measures
- Registered Nurse (RN) will identify and implement interventions to improve performance and develop program goals and plans to meet the health plan’s internal quality goals the needs of external regulatory and oversight entities
- Registered Nurse (RN) will perform computer-based statistical analysis of data related to the QI program and collect data from sources including outpatient lab, claims and other data sources
- Registered Nurse (RN) will monitor and ensure the validity of data, utilize Plan data systems to generate, manipulate and analyze data, evaluate reports for accuracy of data
Qualifications for HEDIS nurse
- Requires a licensed nurse
- 2-4 years of work related experience is required, Prior HEDIS experience is a plus
- Must have basic Excel skills and the ability to type 30-40 WPM
- Candidate must pass a medical record abstraction test prior to starting actual record reviews
- Requires a licensed nurse and must be active for the state in which they will be working
- Of an accredited school of nursing
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HEDIS Nurse Job Description
Job Description Example
Our growing company is hiring for a HEDIS nurse. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for HEDIS nurse
- Registered Nurse (RN) will create process documentation for QI and/or HEDIS activities and collaborates with practices to integrate their electronic medical record data into systems
- Registered Nurse (RN) will collaborate with internal and external stakeholders to identify and act on opportunities for improvement in the area(s) of chronic and/or preventive care
- Registered Nurse (RN) will evaluate, monitor, and report compliance rates on a quarterly basis
- Pass HEDIS IRR and HEDIS Measure Test after training is completed
- Make outreach calls to members with gaps in care to assure adherence with HEDIS measures and contact provider offices to promote clinical compliance
- Work with members to identify and remove barriers and obstacles in obtaining preventive screenings assessing members for chronic condition outreach and barriers to annual screenings per HEDIS
- Educate members related to the specific clinical services/benefits available, HOS components to talk with their provider about, and identify supportive community resources
- Facilitate members obtaining the appropriate clinical services, referrals/care, and medication
- Facilitate appointments and/or reach out to providers as necessary to ensure members are receiving appropriate clinical services and screenings
- Provide health education to promote healthy aging and assess for clinical referral for chronic condition management, behavioral health or complex case management
Qualifications for HEDIS nurse
- Candidates must have strong written, verbal, and interpersonal communication skills
- Knowledge of industry quality improvement methods and tools program design, implementation and evaluation
- AS/BS in nursing with current unrestricted California RN or LVN/LPN license required, BSN preferred
- Must have active or RN license in the state of Washington or compact state
- Some local travel involved
- Must have an understanding of codes for services based on diagnosis and procedure