HEDIS Medical Record Review Project Nurse

Anticipated End Date:

HEDIS Medical Record Review Project Nurse Shift: Monday-Friday

Location:

Virtual:
Must live in FL

This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.

• Will be responsible for HEDIS medical record identification and abstraction throughout the year.
• Serves as a resource and subject matter expert on HEDIS quality reviewer processes.
• Conducts over-reads on HEDIS records for compliance against HEDIS Technical Specifications.
• Educates providers on HEDIS specifications and medical record documentation via various mediums such as HEDIS Encounter Portal Submission Tool, Hybrid Review Tool, HEDIS reference material development, and any other educational pieces for Provider relations, etc.
• Provides feedback to providers via the HEDIS Encounter Submission Tool for medical records reviewed throughout the year.
• Reviews HEDIS Encounter Portal submissions for Star Metrics throughout the calendar year with given set deadlines.
• Works on projects as assigned.
• Develops expertise in the requirements and parameters of mandated HEDIS performance measures on an annual basis.

• Requires a BS in nursing and minimum of 2 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.

• Current, unrestricted clinical license appropriate to field of specialty (LPN/RN) as required.
• Active state license required.
• Minimum of 2 years of experience as a HEDIS medical chart reviewer preferred.

Non-Management Non-Exempt

1st Shift (United States of America)

MED >
Licensed Nurse

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.