Nurse Reviewer- HEDIS/Hybrid Experience

Required
               Nurse Reviewer- HEDIS/Hybrid Experience 
                Remote
                Starting date: January 5, 2026

Candidates will work with the HEDIS team to request, review and abstract medical records to support HEDIS/Hybrid season.

Nurse Reviewer - (RN/LPN) - REMOTE
Ability to work within HEDS documentation systems for Hybrid season
Request, review and abstract medical records as needed.

Key Responsibilities
Collect, abstract, and manage patient medical records and claims data for HEDIS reporting.
Review clinical data to assess compliance with HEDIS guidelines and healthcare quality measures.
Prepare and present detailed reports on healthcare performance to internal teams and external stakeholders.

Perform audits and on-site reviews of healthcare facilities to verify documentation and quality of care.
Collaborate with healthcare providers, quality improvement teams, and insurance companies.
Maintain accuracy and integrity of data in HEDIS databases and reporting platforms.
Stay updated with HEDIS measure changes, NCQA requirements, and regulatory guidelines.
Assist in quality improvement initiatives by identifying gaps and recommending corrective actions.
Ensure adherence to HIPAA standards and confidentiality of patient information.
Train healthcare staff on HEDIS processes and documentation standards when applicable.

Qualifications
Educational background in Nursing (RN, LPN, Certified Healthcare Record Reviewer), or related healthcare discipline preferred.
Experience with data abstraction, medical record review, and healthcare quality measurement.
Knowledge of HEDIS measures, healthcare coding (ICD-10, CPT), and medical terminology.
Proficiency with Electronic Medical Record (EMR) systems and HEDIS reporting software.
Strong analytical, organizational, and communication skills.
Ability to handle sensitive data with discretion and comply with HIPAA regulations.
Detail-oriented with capability to manage multiple tasks and deadlines.