*Actalent is hiring 100% Remote Hedis Nurses- Must sit in or near FL *
- Description:* The HEDIS nurse will review patient charts and abstract data points based on NCQA guidelines.
- Supervise and facilitate successful interventions to meet behavioral health HEDIS and Pay for Performance measures
- Partner with health plans and regional clinical leadership to identify and implement interventions to increase HEDIS rates in behavioral health measures.
- Develop and implement innovative strategies in collaboration with clinical staff to improve compliance with key behavioral health HEDIS metrics and Pay for Performance (P4P) Measures
- Prepare and present financial impact and return on investment on initiatives requiring additional funding or resources
- Act as a liaison with quality improvement, health plan medical management and other departments regarding current and planned interventions, collect input on how to impact these outcomes, and provide feedback to stakeholders on outcomes
- Monitor the effectiveness for new and existing P4P and HEDIS initiatives and ensure appropriate knowledge/education and interventions are conducted for members falling into these measures
- Analyze data to address trends or potential quality and clinical improvement opportunities based on best practices and feedback from involved stakeholders
- Additional Skills & Qualifications:*
- Bachelors degree in nursing, related field, or equivalent experience *
- 3+ years of experience* in case and/or utilization management in a behavioral health or physical health care setting.
- Knowledge of key behavioral or physical health related HEDIS & performance measures required with preferred experience in implementing new interventions to affect these rates.
- Supervisory or lead experience preferred
- Attention to detail
- Ability to be independently productive *
- HEDIS project experience*
- Experience abstracting data from medical records
- Experience in QSHR
- If interested in this opportunity email your resume to: email@example.com*
Actalent connects passion with purpose. Our scalable talent solutions and services capabilities drive value and results and provide the expertise to help our customers achieve more. Every day, our experts around the globe are making an impact. We’re supporting critical initiatives in engineering and sciences that advance how companies serve the world. Actalent promotes consultant care and engagement through experiences that enable continuous development. Our people are the difference. Actalent is an operating company of Allegis Group, the global leader in talent solutions. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.