HEDIS Nurse (REMOTE) at Judge Group

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
• 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).

If you have any questions or would like to learn more, please reach out directly to Nabyla Mendes at NMendesFeitosa@judge.com