Hedis Outreach Nurse
Remote
USD 40-41 / hour
Posted on Oct 30, 2026
HEDIS Nurse (RN/LVN) - Remote
Job Summary
We are seeking a detail-oriented Registered Nurse (RN) or Licensed Vocational Nurse (LVN) to support the Healthcare Informatics 5-Star/HEDIS team. In this role, you will engage with health plan members and provider offices to obtain clinical information, support quality initiatives, and improve Medicare Star Ratings and HEDIS performance measures. This position requires strong knowledge of HEDIS, NCQA technical specifications, and Medicare quality programs.
Length of Assignment: 11/16/28 to 4/30/27
Pay Rate: $40/hr - $41/hr
Key Responsibilities
- Contact health plan members to discuss and coordinate required clinical screenings and preventive care measures.
- Utilize NCQA HEDIS Technical Specifications to assess compliance and identify care gaps.
- Accurately document member interactions and outcomes within HEDIS/5-Star database systems.
- Protect and maintain the confidentiality of protected health information (PHI) in accordance with HIPAA regulations.
- Research and identify missing medical documentation required for HEDIS and Medicare quality measures.
- Communicate with physician offices and healthcare providers via phone and fax to obtain medical records and supporting documentation.
- Escalate complex member or provider issues to the HEDIS Supervisor as appropriate.
- Collaborate with team members to support departmental goals and quality improvement initiatives.
- Contribute to organizational success by supporting Medicare Star Rating and HEDIS performance objectives.
Required Qualifications
Education
- High School Diploma or equivalent required.
Licensure
- Active California Registered Nurse (RN) or Licensed Vocational Nurse (LVN) license required.
Experience
- Minimum of 1 year of HEDIS and Medicare Quality Measures experience required.
- Experience working with medical records abstraction, chart review, or quality improvement initiatives preferred.
Required Knowledge, Skills & Abilities
- Strong understanding of NCQA HEDIS Technical Specifications and Medicare quality programs.
- Excellent verbal and written communication skills.
- Ability to communicate effectively with members, providers, and healthcare office staff.
- Strong attention to detail and accuracy in documentation.
- Ability to manage multiple priorities and meet established deadlines.
- Proficient data entry and computer skills.
- Knowledge of HIPAA and healthcare privacy regulations.
- Ability to work independently in a fast-paced environment while maintaining productivity and quality standards.
Preferred Qualifications
- Previous experience with Medicare Advantage plans, healthcare quality improvement, or population health initiatives.
- Experience working in managed care, health plans, or healthcare informatics environments.
Medical, dental, and vision insurance are available to qualified candidates who meet eligibility requirements
Medical, dental, and vision insurance are available to qualified candidates who meet eligibility requirements.
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