HEDIS Medical Record Review Project Nurse
Core
Conducts HEDIS medical record identification and abstraction, serves as a subject matter expert on quality reviewer processes, and educates providers on HEDIS specifications and documentation requirements.
Role type
HEDIS Medical Record Review Project Nurse
Builds
HEDIS quality metrics and provider feedback via Encounter Portal and Hybrid Review Tools
Domain
Healthcare administration / Quality measurement (HEDIS)
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Medical record abstraction, HEDIS Technical Specifications compliance, Provider education, Star Metrics review, Clinical documentation standards
Preferred skills
HEDIS medical chart review experience, Unrestricted clinical license (LPN/RN), Active state nursing license
Technologies
HEDIS Encounter Portal Submission Tool, Hybrid Review Tool
Responsibilities
Conduct over-reads on HEDIS records for compliance, Educate providers on HEDIS specifications, Provide feedback to providers via submission tools, Review HEDIS Encounter Portal submissions for Star Metrics, Develop expertise in mandated HEDIS performance measures
Seniority
Individual Contributor, Non-Management
