HEDIS RN

WCS Healthcare is partnering with a leading Managed Care Organization in New York City seeking an experienced HEDIS Registered Nurse (RN) to join their Quality Management team. This is an excellent opportunity for a detail-oriented nurse with HEDIS experience who thrives in a fast-paced environment and is passionate about improving healthcare quality outcomes.

Schedule

• Monday - Friday
• 8:30 AM - 5:00 PM
• Hybrid Schedule:
  • In-office Tuesday, Wednesday, and Thursday

Position Overview

The HEDIS RN is responsible for conducting Healthcare Effectiveness Data and Information Set (HEDIS) medical record reviews, supplemental data validation, clinical data abstraction, and data quality initiatives. This role supports the accurate and timely collection of clinical information for HEDIS reporting, regulatory compliance, and quality improvement programs.

The ideal candidate will be comfortable navigating multiple electronic medical record systems, reviewing complex clinical documentation, and ensuring the integrity and accuracy of data used for quality measurement initiatives.

Responsibilities

• Perform comprehensive HEDIS medical record reviews and chart abstractions.
• Validate supplemental clinical data from internal and external sources.
• Review and analyze medical records to identify and capture required HEDIS measures.
• Ensure data accuracy, completeness, and compliance with regulatory guidelines.
• Utilize multiple EMR platforms, including ECW (eClinicalWorks), to obtain and validate clinical information.
• Collaborate with internal quality, clinical, and operations teams to support HEDIS initiatives.
• Maintain strict confidentiality and compliance with HIPAA regulations.
• Meet productivity, quality, and reporting deadlines in a high-volume environment.

Requirements

• Active Registered Nurse (RN) license required.
• ASN or BSN accepted.
• LPNs will not be considered.
• Minimum of 1 year of HEDIS review experience (one HEDIS season alone does not qualify).
• Experience performing medical record abstraction and clinical data review.
• Strong understanding of HEDIS quality measures and reporting processes.
• Ability to work independently with minimal supervision.
• Comfortable working in a fast-paced, high-volume setting.
• Strong organizational skills and attention to detail.
• Proficient with EMR systems and healthcare technology platforms.

Preferred HEDIS Measure Experience

Candidates should have hands-on experience reviewing and abstracting the following measures:

• BCS-E – Breast Cancer Screening
• COL-E – Colorectal Cancer Screening
• EED – Eye Exam for Patients with Diabetes

Ideal Candidate

• Self-starter who can hit the ground running.
• Tech-savvy and adaptable to multiple systems and workflows.
• Maintains professionalism while handling sensitive and confidential information.
• Strong critical thinking and problem-solving skills.
• Committed to delivering high-quality and accurate work.

Interested candidates should have at least one year of recent HEDIS review experience and be available to work onsite in NYC three days per week.

a { text-decoration: none; color: #464feb;}tr th, tr td { border: 1px solid #e6e6e6;}tr th { background-color: #f5f5f5;}Pandologic. Category:Healthcare, Keywords:Registered Nurse (RN), Location:New York, NY-10060