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Registered Nurse - HEDIS


Health and Safety

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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

-Registered Nurse who has an understanding and experience in HEDIS measures

-Candidates (RN) who previously works with STAR Rating programs (Medicare) and HEDIS measurements

-Licensing and registration required.


-short term opportunity 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