A HEDIS Nurse undertakes the crucial task of gathering and analyzing HEDIS performance data. In this role, the nurse will fulfill the various tasks as mentioned on the Hedis Nurse Resume – reviewing assigned medical records, abstracting clinical data, reporting to the health facility’s manager, reviewing medical records and documents, and to abstract clinical data for the HEDIS reporting, integrating collected electronic and hardcopy data into reports, meeting daily abstraction goals and maintaining a high abstraction accuracy percentage, training and advising healthcare professional and administrative staff on HEDIS compliance, and maintaining HIPAA standards and immediately reporting any critical findings.
The most-sought skills include the following – a wide range of experience in electronic medical record software and cloud platforms, solid knowledge of abstracting clinical data and to evaluate HEDIS compliance, advanced knowledge of medical terminologies, coding, and procedures; and extensive experience in interpreting and reporting HEDIS information. A bachelor’s degree in Nursing is needed.
Headline : 12 years professional experience as an RN in various specialties including oncology and med-surg. Strong capacity to serve as a liaison and patient educator in delivering complex and detailed medical information in a clear and concise manor.
Skills : MDS Training In Progress.
Description :
Reviewed and integrated medical information from diverse sources including the health plans internal data base, medical records, and immunization registries, from provider offices in order to abstract specific clinical data for the HEDIS Quality Metric Reporting.
Evaluated improvement opportunities while maintaining the utmost standards of ethics and integrity.
Documented issues and errors within the vendor systems.
Applied knowledge of Medicare/Medicaid requirements for disease management and prevention.
Evaluated improvement opportunities while maintaining the utmost standards of ethics and integrity.
Vendor software applications utilized: outcomes health information system, alert analytics, med- capture, hybrid health, and idc data bases.
Applied knowledge of medicare/medicaid requirements for disease management and prevention.
Experience
5-7 Years
Level
Consultant
Education
Bachelor In Nursing
Hedis Nurse Resume
Headline : Organize and review medical records for analysis. Strong commitment to promoting wellness and preventing disease. Ability to work independently and proactively aid in the building of a team atmosphere.
Skills : Outcomes Health Information System, Alert Analytics, Med- Capture, Hybrid Health, and IDC data bases.
Description :
Reviewed medical records and documents to abstract clinical data for HEDIS reporting.
Integrated collected electronic and hardcopy data into reports.
Documented findings in applicable HEDIS databases and on prescribed cloud-based platforms.
Met daily abstraction goals and maintaining a high abstraction accuracy percentage.
Performed on-site facility audits for compliance with HEDIS measures.
Prepared and presented HEDIS compliance reports to health facility managers.
Trained and advised healthcare professionals and administrative staff on HEDIS compliance.
Experience
5-7 Years
Level
Executive
Education
Nursing
Hedis Nurse Resume
Summary : Hedis nurses review medical records to determine how well healthcare providers are caring for their patients.
Skills : RN, LPN, or LVN
Description :
Passed HEDIS IRR and HEDIS Measure Test after training is completed.
Made outreach calls to members with gaps in care to assure adherence with HEDIS measures and contact provider offices to promote clinical compliance.
Worked with members to identify and remove barriers and obstacles in obtaining preventive screenings assessing members for chronic condition outreach and barriers to annual screenings per HEDIS.
Educated members related to the specific clinical services/benefits available, HOS components to talk with their provider about, and identify supportive community resources.
Facilitated members obtaining the appropriate clinical services, referrals/care, and medication.
Facilitated appointments and/or reach out to providers as necessary to ensure members are receiving appropriate clinical services and screenings.
Provided health education to promote healthy aging and assess for clinical referral for chronic condition management, behavioral health or complex case management.
Experience
7-10 Years
Level
Management
Education
Registered Health
Hedis Nurse Resume
Headline : HEDIS Nurses assess whether healthcare services comply with prescribed Healthcare Effectiveness Data Information Set (HEDIS) measurements.
Skills : Electronic Medical Record (EMR) software and cloud platforms, such as Cliniko and Inovalon.
Description :
Assembled and organized all medical documents and information needed to manage the case.
Coordinated all parties involved in the medical case: the client and his family; the Case Manager; the medical specialists globally; and other medical parties. Schedule meetings and phone calls, confirming their execution.
Oversaw the execution and outcome of the clinical plan as developed by the multidisciplinary team.
Updated the Head Nurse and Operations Supervisor regarding the status of the medical cases, as well as reporting any problem or special situation in need of immediate attention to the case manager and or the Global Medical Director.
Established a relationship with the client and his family and be fully acquainted with his/her medical case. Be a positive driver in a successful participation and working according to the highest service level agreements.
Assisted the Case Managers in the management of the cases and the Global Medical Director in the quality control process.
Identified and monitored the client and his/her medical condition and well-being.
Experience
5-7 Years
Level
Executive
Education
Registered Health
Hedis Nurse Resume
Headline : As a Hedis Nurse, clinical data from medical records and documents, prepare integrated reports from collected data, and document their findings for physicians and healthcare facility managers to act upon.
Skills : In-depth knowledge of abstracting clinical data and evaluating HEDIS compliance.
Description :
Evaluated quality improvement outcomes.
Gathered and analyzed performance data.
Reviewed and assessed medical records.
Participated in on-site inspection preparation.
Conducted facility audits regarding compliance.
Presented findings to Quality Improvement Committee (QIC).
Updated clinical quality metrics.
Experience
5-7 Years
Level
Executive
Education
Nursing
Hedis Nurse Resume
Headline : As a Hedis Nurse, reviewing assigned medical records, abstracting relevant clinical data, and reporting to the health facility managers on whether healthcare provision standards are being met.
Skills : Excellent organizational and communication skills.
Description :
Conducted research in a thoughtful and methodical search in order to locate specific claim information, including all resources provided in order to find best information.
Reviewed and abstracted paper and electronic medical records utilizing NCQA HEDIS Technical specifications to optimize Plan HEDIS scores.
Performed complete and accurate data entry of qualifying services and results into HEDIS electronic database software.
Identified and communicated patterns of missing documentation for the assessment of additional records.
Routed all exclusions and complex issues to the Quality Improvement Nurse.
Met or exceeded accuracy standard of 95% and turn around standard of 24-48 hours for medical record review and data entry.
Attended department meetings and delivers hard copy records weekly.
Experience
5-7 Years
Level
Executive
Education
Nursing
Hedis Nurse Resume
Headline : Hedis nursing is a form of non-clinical nursing where nursing professionals analyze data to determine the effectiveness of health plans.
Skills : Strong organizational skills and ability to work both independently and with teams.
Description :
Managed data capture and integrity and ensure data from internal/external data sources incorporated into HEDIS/QARR/Stars.
Identified data improvement opportunities through QA of HEDIS/QARR/Star reports and data outputs and detecting data acquisition, capture, and system error issues.
Managed necessary changes for operational processing, data flow, collection and distribution to positively impact HEDIS/QARR/Star results.
Pro activate explore, seek, and apply existing and new internal and external data sources and various methods.
Analyzed plan structured and unstructured data across different systems and platforms through various data manipulation, cleaning, and merging techniques.
Assisted in the management of implementing corrective actions and re-evaluates impact based on actions taken.
Conducted evaluation studies and root-cause analyses to identify improvement area(s) and understanding of the marketplace.
Experience
5-7 Years
Level
Executive
Education
Nursing
Hedis Nurse Resume
Headline : Hedis Nurses exhibit extensive experience in analyzing medical records and sound knowledge of HEDIS measures.
Skills : Proficiency in software applications that include, but are not limited to, Microsoft Word, Microsoft Excel. Outlook.
Description :
Worked with the HEDIS team to collect member records and conduct reviews of these records.
Worked under the supervision of internal staff.
Reviewed data analysis and research within the company systems.
Participated in collection and review of annual HEDIS data.
Participated in required audits to meet all accreditation and regulatory requirements.
Conducted Medical Record Review and coordination of continuity of care studies.
Reviewed and investigated quality of care issues following prescribed guidelines and implementation of appropriate / timely actions.
Experience
5-7 Years
Level
Executive
Education
Nursing
Hedis Nurse Resume
Headline : Hedis Nurse provides assistance to the Clinical Measurement and Improvement team in delivering necessary program documents, operations, and improvements for relevant accreditation, transparency, community collaboratives, and HEDIS reporting requirements.
Skills : RHIA, RHIT, CPC, CCS.
Description :
Collected member records and conduct reviews of these records as per NCQA HEDIS specifications.
Audited/reviewed case manager and provider clinical documentation and telephone interactions against regulations, accreditation standards and contract requirements.
Reviewed provider treatment records against clinical and procedural established standards.
Conducted ongoing activities which monitor established quality of care standards in the participating provider network and for care managers.
Collected, analyzed and prepared clinical record information for projects related to assessing the efficiency, effectiveness and quality of the delivery of managed care services.
Presented findings at provider and customer meetings as needed.
Assisted in the planning and implementation of activities to improve delivery of services and quality of care including the development and coordination of in-service education programs for providers and care managers.
Experience
5-7 Years
Level
Executive
Education
Health Care
Hedis Nurse Resume
Headline : As a Hedis Nurse, protects patients and employees by adhering to infection-control policies and protocols; medication administration and storage procedures; and controlled substance regulations.
Skills : Windows and Microsoft Office, HIPAA rules and regulations, Microsoft Office, Specifically Excel.
Description :
Traveled to physician offices as needed.
Communicated as much as possible via phone and fax.
Adhered to measured productivity requirements, module testing and at times re-testing to meet minimum requirements.
Performed research on internal claims systems
Developed and shared strategies to accomplish goals.
Worked under the supervision of the managed care company internal staff.
Designated lead in order to achieve goals and keep the project moving.
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