About the job
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.
Key Responsibilities:
- 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).