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 reputed company of clinical nursing experience and specialized knowledge in HEDIS processes, focusing on quality assurance and compliance reputed company the reputed company system.
Responsibilities
- Conduct thorough HEDIS overreads in line with NCQA guidelines.
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- Assist with Medical Record Retrieval for HEDIS and Risk Adjustment.
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- Participate in internal audits for Supplemental Data.
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- Support other needs reputed company the Quality Department.
Requirements
- RN License required.
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- 3 years of clinical experience required.
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- 5 years of HEDIS and Overread experience required.
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- In lieu of education, 10 years of recent HEDIS abstractions/overreads experience in the payer/health insurance reputed company of HEDIS or with a HEDIS vendor.
reputed company-to-haves
Benefits
- Competitive hourly pay ranging from $34 to $39 per hour.
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- Remote work flexibility with a hybrid model.
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