HEDIS Nurse Reviewer – New England Region

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🦞 Maine – Remote

🦞 Maine – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Martin's Point Health Care

WebsiteLinkedInAll Job Openings

501 - 1000 employees

⚕️ Healthcare Insurance

🧘 Wellness

Healthcare Insurance • Wellness

Martin's Point Health Care is a healthcare organization committed to serving its local communities through high-quality primary and specialty care services. The organization places a strong emphasis on creating a positive workplace culture, recognizing employee contributions, and fostering workforce diversity. Martin's Point Health Care offers a range of career opportunities across various departments, from healthcare providers to corporate roles, and supports employee growth through competitive compensation, development programs, and generous perks. Additionally, the company is recognized for its community impact efforts, raising significant funds for community organizations and encouraging employee volunteerism.

📋 Description

• Performs clinical chart reviews and audits to ensure accuracy and compliance with HEDIS measures. • Develops reports to identify HEDIS care gaps and trends and works closely with providers to ensure the necessary services are provided and documented according to HEDIS requirements. • Assists in the coordination of outreach efforts to request, collect, and secure clinical documentation from individual providers or provider groups as indicated by individual HEDIS measure specifications. • Collaborates with health plan departments to identify HEDIS data sources and develop systems to capture this data in accordance with HEDIS technical specifications, such as supplemental databases. • Collaborates with data analysts and quality teams to support performance improvement. • Documents findings and recommends strategies to improve HEDIS measure performance. • Applies clinical expertise to identify and validate data discrepancies. • Educates non-clinical staff on HEDIS requirements and clinical relevance of data. • Corresponds with members and clinical providers to effectively coordinate care, obtain medical records, and ensure patients receive preventive and chronic disease management services.

🎯 Requirements

• Bachelor’s degree in nursing required • 5+ years of experience in the health care industry, in HEDIS and/or quality improvement • Experience in managed care health services environment • NCQA and HEDIS Experience • Active and unrestricted Nursing license

🏖️ Benefits

• Health care coverage • Professional development opportunities • Annual training provided