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Clinical Quality HEDIS Reviewer

https://www.roberthalf.com Logo

Robert Half

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Location:
United States , Eden Prairie

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Category:
Nursing

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Contract Type:
Not provided

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Salary:

Not provided
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Job Description:

This role performs ongoing analysis of charts for various STARS and HEDIS® quality measures. The information obtained during these reviews will work to close quality measure gaps as well drive other teams work on provider education on behalf of the insurance plan. Individual must be highly organized, possess strong critical thinking skills, with demonstrated professional maturity and emotional resilience. Day to day work varies based on time of year, with overarching goal to generate completely accurate chart abstraction resulting in improved HEDIS® or other quality program rates. The role requires utilization of multiple sources of information, medical record collection tracking tools, and electronic medical record systems.

Job Responsibility:

  • Support chart chase processes by requesting records from provider offices as needed
  • Primary source verify abstracted medical record data
  • Over read abstracted and verified medical record data
  • Analyze chart data evaluate for possible data integrity and/or data deficits and document findings
  • Provide education and feedback to primary source verifiers and/or abstractors
  • Meet and maintain production and quality expectations for all assigned measures
  • Responsible for managing and utilizing confidential information from medical records in an appropriate manner following designated guidelines including HIPAA and company policies/guidelines
  • Support Chart Chase Review and abstract medical record data into appropriate applications
  • Navigate multiple documentation systems and obtain medical record sections supportive of HEDIS/Star measures
  • Applies HEDIS® concepts and principles in the completion of abstraction and review process to ensure full recognition of delivered care for the benefit of the member
  • Transition between priorities and abstraction projects based on program or client needs
  • Ability to work in a self-directive manner and apply critical thinking/problem solving skills by referencing available Technical Specifications, Business Process Documentation, Job Aids, and other tools for clarity/guidance as needed

Requirements:

  • Registered Nurse
  • Two or more years of HEDIS/STAR experience
  • Three or more years of experience with data analysis/quality chart reviews
  • Must be able to review data and provide recommendations for improvement
  • Excellent communication practices both oral and written
  • Experience using Microsoft office applications including databases word-processing and Excel spreadsheets
  • Designated workplace at home free of distractions
  • Reliable, highspeed internet connection
  • Ability to contact providers and request data independently, by telephone and in writing
  • Experience and confidence with placing outbound phone calls
  • Proficient in Microsoft Office applications including Excel, Outlook, Word
What we offer:
  • medical
  • vision
  • dental
  • life and disability insurance
  • 401(k) plan

Additional Information:

Job Posted:
March 01, 2026

Work Type:
Remote work
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