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HEDIS Reviewer / Consultant


Health and Safety

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Job Type




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No. of Openings


Branch Information

Mayaguez, PR - (USA) Carr. #2, Km 165.8, Bo. Lavadero Edif. Alemar Plaza Suite 3 PR Hormigueros , PR - 00660 Phone : 787-834-3900



Job Description

-Candidate who has an understanding and experience in HEDIS measures


-short term opportunity that should start on January for a period of 20 weeks.

HEDIS Outreach & Review work

* Review Medical charts note (paper and electronic - EMR) and identify gaps in care

* Data extraction and maintain the HEDIS data for annual submission

* Reach out to Physicians/Provider office for closing gaps in care

* Conduct telephonic member outreach for needs assessments

* Help coordinate doctor appointments and make follow-up calls to members after appointment

* Assist members in overall wellness and prevention

* Perform HEDIS audits

* Provide clinical support for all HEDIS related projects and interventions initiated by the Quality Department

* Assist in the development of new HEDIS interventions and corrective action plans for HEDIS measures that fall below goals

HEDIS Consultant

* Participate in quality improvement initiatives

* Develop recommendations for quality remediation plans

* Create databases to capture relevant data for each region

* Provide analytical interpretation of HEDIS reporting to provider groups

* Develop market business plans to motivate providers to engage in improving Stars measures

* Analyze and evaluate provider group structure and characteristics, provider group / provider office operations and personnel to identify the most effective approaches and strategies

* Identify and assess decision makers and other key provider group personnel with a focus on identifying barriers to achieving targeted outcomes

Medical record collection and data abstraction; clinical knowledge preferred but not required

-have ability to set-up and use laptops, mobile wireless internet and other equipment

-use Microsoft Word, Excel, Adobe reader, Outlook email

-read and interpret hand written and electronic medical records

-accurately enter specific data elements from records into company software systems

-use multiple online and company systems to save, share, annotate and transfer files

-perform follow-up as needed, contact medical offices, speak with staff and physicians as needed

-be available for regular conference calls, staff meetings, and training sessions

-communicate with other team members online and by phone

Plan, direct, or coordinate activities of an organization to ensure compliance with ethical or regulatory standards. Assess product, compliance, or operational risks and develop risk management strategies.