HEDIS Nurse

This is a fully remote position, open to applicants in California.

📋 Description

• Evaluate medical records for Quality Initiatives/HEDIS® reporting

• Engage with members and/or providers to gather essential data and complete medical records and reporting information

• Discuss medication adherence and necessary procedures to address care gaps, including bone density testing and colorectal cancer screenings

• Extract clinical data from medical records according to NCQA standards and internal protocols

• Communicate with members and providers about Quality Initiative projects and record findings in the specified database

• Document all interactions with members as instructed by the project manager

• Identify opportunities for pursuit and collaborate with pursuit assistants to obtain medical record information

• Assess clinical information to retrieve required data from members and/or providers within project deadlines

• Actively pursue missing data throughout the review process

• Adhere to project manager directives to achieve project goals and timelines

• Collaborate with HEDIS® staff to update and monitor medical records for reporting

• Maintain professional and technical expertise through educational workshops, professional literature, personal networks, and professional organizations

• Assist with projects and interventions across various departments as necessary

• Review medical records and extract relevant information as directed by the project manager

• Uphold SCAN’s vision and goals

• Carry out additional duties as assigned

⛳️ Requirements

• Associate's Degree or equivalent experience or Technical Degree

• Registered Nurse (RN) or Licensed Vocational Nurse (LVN) certification required

• 2-3 years of relevant experience

• 0-1 years of leadership experience

• Familiarity with the field's policies, procedures, and practices

• Capable of leading and directing the work of other employees

• Background check required

• Interest in AI and its potential to transform operations and member services

🏝️ Benefits

• This is a temporary position for a specified duration

• Opportunity for remote work

• Medical benefits provided

• Paid sick time available

• Excellent 401(k) retirement savings plan

• Comprehensive employee recognition program

• Opportunity to be part of a team that positively impacts our members and community every day