HEDIS Nurse

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

📋 Description

• Assess medical records for Quality Initiatives/HEDIS® reporting.

• Reach out to members and/or providers to gather essential data, ensuring comprehensive medical records and reporting details.

• Address medication adherence and the procedures necessary to fill care gaps, including bone density testing and colorectal cancer screenings.

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

• Engage with members and providers regarding Quality Initiative projects, recording findings in the designated database.

• Precisely document all member interactions as outlined by the project manager.

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

• Analyze clinical information to gather required data from members and/or providers within project deadlines.

• Seek out missing data throughout the records review process.

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

• Work in coordination with HEDIS® staff to update and monitor medical records for reporting purposes.

• Keep professional and technical expertise up to date through educational workshops, professional publications, personal networks, and professional organizations.

• Assist with projects and interventions within or across departments as necessary, including HCS and Pharmacy.

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

• Actively contribute to SCAN’s Vision and Goals.

• Execute additional duties as assigned.

⛳️ Requirements

• Associate's Degree or equivalent experience or Technical Degree.

• Registered Nurse (RN) or Licensed Vocational Nurse (LVN) is 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.

• Level I supervisors generally have limited authority over personnel matters.

• A background check is mandatory.

• Interest in AI and its potential to revolutionize operations and service to our members.

🏝️ Benefits

• This is a temporary opportunity for a limited duration.

• Medical Benefits.

• Paid Sick Time.

• Excellent 401(k) Retirement Savings Plan.

• Comprehensive employee recognition program.

• An opportunity to join a team that makes a positive impact on our members and our community every day!