Job description
We are seeking experienced HEDIS nurses to support the Health Care Informatics 5 Star/HEDIS team. The role involves contacting members regarding specific clinical screenings needed to improve 5 Star/HEDIS scores. Successful candidates will perform data entry, documentation review, and coordination of care, working independently in a fast-paced, remote environment.
• Job Title: HEDIS Nurse (Remote)
• Start Date: December 2nd
• Work Hours: 8:00 AM – 5:00 PM PST
• This is a REMOTE position, requiring candidates to excel in a fast-paced environment and manage tasks efficiently.
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• Utilize knowledge of NCQA HEDIS Technical Specifications to measure compliance and engage members.
• Perform accurate data entry and document communications in 5-Star/HEDIS electronic databases.
• Maintain the confidentiality of private health information, ensuring compliance with operational guidelines.
• Identify and report gaps in documentation, making outreach calls to members and medical offices to gather missing information.
• Escalate complex issues to the Supervisor as needed.
• Contribute to team efforts by supporting overall HEDIS/5 Star goals and objectives.
Qualifications:
• Education: High School Diploma or equivalent.
• Certification: Active RN or LVN license in California.
• Experience:
• 1+ years of experience with HEDIS and Medicare measures.
• Familiarity with NCQA HEDIS Technical Specifications.
• Strong communication skills, attention to detail, and ability to manage multiple tasks within time constraints.
• Preferred Skills:
• Previous experience in medical office settings or healthcare coordination.
• Ability to work independently and be resourceful in problem-solving.
• Strong customer service skills, particularly with phone outreach and answering benefit-related questions.
• Experience with diagnosis verification, coordination of care (COC), and conducting Health Risk Assessments (HRA).
