You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.

Job Summary

Our client is seeking an experienced HEDIS Nurse to support its annual HEDIS and healthcare quality initiatives. This role involves reviewing medical records and clinical documentation, identifying relevant clinical information, abstracting data, and accurately documenting findings in accordance with HEDIS specifications, NCQA standards, and quality requirements. It is a detail-oriented, production-focused clinical position centered on medical record review and data abstraction rather than direct patient care.

Key Responsibilities

• Conduct detailed reviews of medical records to identify clinical information relevant to assigned HEDIS measures.
• Review physician notes, hospital records, laboratory results, medication records, claims information, procedure documentation, and other medical records.
• Identify and abstract required clinical data accurately according to established HEDIS technical specifications.
• Determine whether documentation meets numerator compliance requirements for applicable HEDIS measures.
• Identify gaps in care, missing documentation, and opportunities to improve quality measure performance.
• Accurately enter and maintain clinical information in designated HEDIS/quality management systems.
• Apply clinical judgment when interpreting medical terminology, diagnoses, procedures, laboratory results, and treatment documentation.
• Ensure all abstracted information is supported by appropriate medical record documentation.
• Follow current NCQA/HEDIS specifications, MVP policies, and established chart abstraction guidelines.
• Maintain a high level of accuracy and consistency across chart reviews.
• Meet established productivity and quality expectations for assigned HEDIS projects.
• Participate in internal quality assurance audits and remediation activities.
• Correct identified abstraction errors and incorporate feedback into future reviews.
• Maintain strict confidentiality and comply with HIPAA and all applicable state and federal regulations.
• Stay current on changes to HEDIS measures, technical specifications, clinical guidelines, and quality reporting requirements.
• Identify members who have outstanding preventive care, chronic disease management, screening, or other quality gaps.
• Recognize documentation that supports closure of identified care gaps.
• Escalate questionable or incomplete documentation according to established workflows.
• Support quality improvement initiatives designed to improve member outcomes and HEDIS performance.
• Work collaboratively with Quality, Clinical Operations, Care Management, Provider Relations, Data Analytics, and other internal teams.
• Communicate effectively with clinical and non-clinical team members regarding chart review findings.
• Participate in team meetings, calibration sessions, training, and ongoing education.
• Assist with special quality projects and other medical record review initiatives as assigned.

Qualifications

• Current, unrestricted Licensed Practical Nurse (LPN) license in New York.
• Minimum 2 years of clinical nursing experience.
• Strong understanding of medical terminology, diagnoses, medications, procedures, and clinical documentation.
• Strong computer skills and ability to navigate electronic medical record systems.
• Exceptional attention to detail and accuracy.
• Ability to work independently and meet productivity expectations.
• Experience with medical record review, chart abstraction, managed care, quality, or population health preferred.
• Previous health plan, managed care, Medicaid, Medicare, or Medicare Advantage experience preferred.
• Experience with quality improvement or population health programs preferred.
• Experience working with electronic health records and multiple clinical databases preferred.
• Familiarity with common HEDIS measures (e.g., Breast Cancer Screening, Colorectal Cancer Screening, Cervical Cancer Screening, Diabetes Screening and Monitoring, Controlling High Blood Pressure, Medication Adherence, Immunizations, Prenatal/Postpartum Care, Well-Child and Adolescent Well-Care, Comprehensive Diabetes Care, Behavioral health-related quality measures) preferred.
• Knowledge of CMS Stars, Medicaid quality measures, or other health plan quality programs preferred.

Experience

• Minimum 2 years of clinical nursing experience.
• Experience with medical record review, chart abstraction, managed care, quality, or population health preferred.

Skills

• Strong understanding of medical terminology, diagnoses, medications, procedures, and clinical documentation.
• Strong computer skills and ability to navigate electronic medical record systems.
• Exceptional attention to detail and accuracy.
• Ability to work independently and meet productivity expectations.
• Ability to interpret medical records efficiently.

Education

• Current, unrestricted Licensed Practical Nurse (LPN) license in New York.

Additional Requirements

• Typical schedule is Monday-Friday, 8:30 AM - 5:00 PM; however, flexibility with hours may be accommodated.

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

^*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

Medix Overview:

With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.

Any required state or Joint Commission training is compensated at the state or local minimum wage rate.

^*As a job position within our Care Management division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, access and handling of patient medical records, providing medical care inside a patient’s residential address, driving, prescription and other drug access and administration, and working with vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.