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.
Objective : Dedicated HEDIS Nurse with 2 years of experience analyzing clinical data to enhance healthcare delivery. Proficient in abstracting data from medical records to ensure compliance with HEDIS standards. Passionate about improving patient outcomes through meticulous data review and quality assessment. Committed to contributing effectively to healthcare teams and driving quality improvement initiatives.
Skills : Clinical Assessment, Patient Education, Data Analysis, Quality Improvement
Description :
Conducted thorough reviews of medical records to extract clinical data for HEDIS Quality Metric Reporting.
Identified improvement opportunities while upholding ethical standards in healthcare.
Documented discrepancies and errors within vendor systems to enhance data accuracy.
Applied knowledge of Medicare and Medicaid regulations for effective disease management.
Utilized advanced vendor software applications to manage health information systems.
Collaborated with healthcare teams to ensure compliance with HEDIS measures.
Analyzed data trends to support quality improvement initiatives across healthcare settings.
Experience
0-2 Years
Level
Entry Level
Education
BSN
Hedis Nurse Specialist Resume
Objective : Results-oriented HEDIS Nurse Specialist with 5 years of experience in clinical data analysis and reporting. Expertise in abstracting medical records to meet HEDIS compliance standards and drive quality improvement initiatives. Adept at collaborating with healthcare teams to enhance patient outcomes through effective data management and quality assessments.
Skills : Clinical Outcomes Analysis, Data Analytics And Reporting, Health Information Management, Integrated Care Coordination, Patient Engagement
Description :
Reviewed and abstracted clinical data from medical records for HEDIS reporting.
Compiled and analyzed electronic and hardcopy data for accurate reporting.
Maintained documentation in HEDIS databases and cloud-based systems.
Consistently met daily abstraction goals while ensuring a high accuracy percentage.
Conducted compliance audits on-site to verify adherence to HEDIS measures.
Prepared and delivered compliance reports to healthcare facility management.
Educated healthcare staff on HEDIS compliance and best practices.
Experience
2-5 Years
Level
Junior
Education
BSN
Hedis Nurse Resume
Headline : Accomplished HEDIS Nurse with 7 years of extensive experience in clinical data analysis and quality improvement initiatives. Expert in abstracting medical records to ensure compliance with HEDIS standards, driving enhancements in patient care. Passionate about optimizing healthcare outcomes through strategic data management and collaboration with multidisciplinary teams.
Skills : Clinical Data Analysis, Quality Improvement Initiatives, Team Leadership, Training And Mentoring, Patient-centered Care, Resource Management
Description :
Passed HEDIS IRR and HEDIS Measure Test following comprehensive training.
Conducted outreach to members with care gaps, ensuring adherence to HEDIS measures and promoting clinical compliance.
Identified and addressed barriers to preventive screenings for chronic conditions, enhancing member engagement.
Educated members on available clinical services and community resources to improve health outcomes.
Facilitated access to necessary clinical services, referrals, and medications for members.
Coordinated with providers to confirm members received essential screenings and services.
Delivered health education to promote wellness and assess needs for chronic condition management.
Experience
5-7 Years
Level
Senior
Education
BSN
Hedis Nurse Consultant Resume
Summary : With a decade of expertise as a HEDIS Nurse Consultant, I excel in evaluating healthcare data to ensure compliance with HEDIS standards. My commitment to enhancing patient care through data-driven insights and quality improvement initiatives has consistently delivered measurable outcomes. I thrive in collaborative environments, driving efficiency and effectiveness in healthcare delivery.
Skills : Healthcare Data Management Systems, Health Record Review, Regulatory Compliance, Chronic Disease Management, Patient Advocacy, Interdisciplinary Collaboration
Description :
Coordinated comprehensive medical case management, ensuring all documentation is organized and accessible.
Collaborated with multidisciplinary teams to execute clinical plans and monitor patient progress.
Maintained clear communication with stakeholders, providing updates on case statuses and immediate issues.
Assisted in quality assurance processes, enhancing overall patient care delivery.
Established rapport with patients and families, ensuring a thorough understanding of medical cases.
Identified trends in patient data to inform quality improvement strategies.
Facilitated training sessions for staff on HEDIS compliance and best practices in data management.
Experience
7-10 Years
Level
Consultant
Education
BSN
Hedis Nurse Resume
Summary : Bringing a decade of experience as a HEDIS Nurse, I specialize in analyzing clinical data to ensure adherence to HEDIS standards. My expertise lies in extracting and interpreting data to enhance patient outcomes. I am dedicated to fostering collaboration among healthcare teams and driving impactful quality improvement initiatives in patient care.
Skills : Patient Safety, Utilization Review, Nursing Process, Cultural Competence, Communication Skills, Time Management
Description :
Evaluated quality improvement outcomes and ensured alignment with HEDIS metrics.
Gathered and analyzed performance data to identify trends and areas for improvement.
Participated in on-site inspections, ensuring compliance with health regulations.
Conducted facility audits to assess adherence to HEDIS standards.
Presented findings to the Quality Improvement Committee (QIC) for actionable insights.
Updated and managed clinical quality metrics to support continuous improvement.
Collaborated with multidisciplinary teams to enhance patient care strategies.
Experience
10+ Years
Level
Management
Education
BSN
Hedis Nurse Coordinator Resume
Objective : Innovative HEDIS Nurse Coordinator with 2 years of experience in clinical data analysis and quality assessment. Skilled in extracting and interpreting medical records to ensure compliance with HEDIS standards. Dedicated to fostering collaboration among healthcare teams to enhance patient outcomes and drive continuous quality improvement initiatives.
Skills : Data Management And Analysis Skills, Evidence-based Practice, Health Promotion, Preventive Care
Description :
Conduct comprehensive medical record reviews for HEDIS compliance.
Utilized NCQA HEDIS Technical specifications to optimize healthcare performance metrics.
Performed accurate data entry into HEDIS electronic databases, ensuring high-quality reporting.
Identified documentation deficiencies and collaborated with healthcare teams to address gaps.
Escalated complex issues to the Quality Improvement Nurse for resolution.
Maintained a 95% accuracy standard and a turnaround time of 24-48 hours for data processing.
Participated in departmental meetings, contributing insights on data trends and improvement strategies.
Experience
0-2 Years
Level
Entry Level
Education
BSN
Hedis Nurse Resume
Headline : Accomplished HEDIS Nurse with over 7 years of experience in clinical data analysis and quality assurance. Adept at extracting and interpreting medical records to ensure compliance with HEDIS standards. Driven to enhance patient care through effective data management and collaboration with healthcare teams, consistently achieving measurable improvements in health outcomes.
Skills : Data Management And Integrity, Health Policy Knowledge, Outcome Measurement, Health Informatics, Risk Assessment, Quality Assurance
Description :
Managed data capture and integrity to ensure accurate incorporation of internal and external data sources into HEDIS and QARR Stars programs.
Identified data improvement opportunities through quality assurance of HEDIS and QARR Star reports, detecting data acquisition and system error issues.
Facilitated operational processing changes to enhance data flow, collection, and distribution, positively impacting HEDIS results.
Proactively explored and applied existing and new data sources and methodologies for comprehensive data analysis.
Ensure accurate documentation for HEDIS reporting requirements.
Assisted in implementing corrective actions, re-evaluating the impact of those actions on data accuracy and quality.
Conducted evaluations and root-cause analyses to identify areas for improvement and market understanding.
Experience
5-7 Years
Level
Senior
Education
BSN
Hedis Nurse Manager Resume
Summary : Dynamic HEDIS Nurse Manager with 10 years of experience in clinical data analysis and quality improvement. Expertise in managing HEDIS compliance initiatives, driving team performance, and optimizing patient outcomes through data-driven insights. Committed to fostering collaboration among healthcare professionals to enhance care delivery and achieve measurable improvements.
Skills : Attention To Detail, Technical Proficiency, Care Coordination, Medication Management, Care Plan Development, Documentation Skills
Description :
Oversaw the collection and review of HEDIS data to ensure compliance with national standards.
Conducted in-depth data analysis to identify areas for improvement in patient care.
Collaborated with multidisciplinary teams to implement quality initiatives and ensure optimal patient outcomes.
Managed audits to meet accreditation and regulatory requirements effectively.
Led Medical Record Reviews and continuity of care studies to enhance healthcare delivery.
Identified and addressed quality of care issues, implementing corrective actions as needed.
Developed training materials and conducted workshops to educate staff on HEDIS measures and compliance.
Experience
7-10 Years
Level
Management
Education
BSN
Hedis Nurse Resume
Objective : Skilled HEDIS Nurse with 2 years of experience in clinical data analysis and quality improvement. Proficient in data abstraction from medical records to ensure compliance with HEDIS standards. Focused on enhancing patient outcomes through effective collaboration and quality assessment initiatives. Eager to contribute to team efforts in delivering superior healthcare services.
Skills : Registered Health Information Administrator, Registered Health Information Technician, Certified Professional Coder, Health Disparities, Critical Thinking, Problem Solving
Description :
Collected and reviewed member records in accordance with NCQA HEDIS specifications.
Audited clinical documentation and interactions to ensure compliance with accreditation standards.
Prepare reports and presentations on HEDIS findings.
Monitored quality of care standards within the provider network and among care managers.
Analyzed clinical record information to assess the effectiveness of managed care services.
Presented findings at provider and stakeholder meetings to drive improvements.
Assisted in planning and implementing quality improvement initiatives and educational programs.
Experience
0-2 Years
Level
Fresher
Education
BSN
Hedis Nurse Resume
Objective : Experienced HEDIS Nurse with 5 years dedicated to enhancing healthcare quality through comprehensive clinical data analysis. Skilled in data abstraction and ensuring compliance with HEDIS standards, I focus on improving patient outcomes by collaborating with multidisciplinary teams. My commitment to quality improvement drives successful initiatives that positively impact patient care.
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