Hedis Manager Jobs in Boca Raton, FL (NOW HIRING)

Position Summary: 

The Advanced Registered Nurse Practitioner (ARNP) provides primary care services to patients within Nuvia Medical’s value-based care delivery model. The ARNP functions autonomously and in collaboration with physicians and the care team to deliver comprehensive, patient-centered healthcare. The provider manages acute and chronic conditions, coordinates preventive services, and promotes optimal health outcomes for a defined patient panel. Care is delivered in collaboration with care coordination staff and the Quality Assurance team, as well as other Nuvia Medical stakeholders, to close gaps in care, meet HEDIS and Continuity-of-Care (COC) measures, and reduce avoidable ER visits and hospitalizations. The ARNP plays a key role in managing cost-effective, high-quality care for predominantly Medicaid patients, ensuring equitable access to care and adherence to Nuvia’s population health goals. 

Essential Duties and Responsibilities: 

• Provide comprehensive outpatient primary care services, including health assessments, diagnosis, treatment, and follow-up for acute and chronic conditions.
• Deliver care within a per-member-per-month (PMPM) model focused on prevention, quality, andappropriate utilizationof healthcare resources.
• Collaborate with physicians, care coordination staff, and the Quality Assurance team toidentifyand close HEDIS and Continuity-of-Care (COC) gaps.
• Develop and implement individualized care plans tooptimizehealth outcomes and minimize avoidable hospital and emergency roomutilization.
• Perform screenings, health maintenance exams, and age-appropriate immunizations and counseling based on clinical guidelines.
• Provide patient education, self-management support, and motivational counseling to promote adherence and health literacy.
• Work collaboratively with the multidisciplinary care team, including social services and behavioral health, to coordinate care for high-risk and complex patients.
• Participate in population health initiatives, quality improvement projects, and clinical performance reviews to improve outcomes across assigned panels.
• Document all patientencountersthoroughly and accurately in the electronic health record (EHR) in compliance with organizational and regulatory requirements.
• Monitor, analyze, and act on quality data andutilizationreports to support Nuvia’s medical loss ratio (MLR) and performance-basedobjectives.
• Maintain knowledge of current clinical standards, evidence-based practices, and value-based care principles.
• Support Nuvia’s culture of compassion, accountability, and continuous improvement through participation in team meetings and professional development activities.

Required Qualifications: 

• Master’s degree in Nursingfrom an accredited program with national certification as a Family or Adult Nurse Practitioner.
• Current, unrestricted license to practice as an Advanced Registered Nurse Practitioner in the State of Florida.
• Current DEA registration and prescriptive authority.
• Minimum of two (2) years of experience in a primary care, managed care, or value-based care environment preferred.
• Experience with Medicaid and underserved patient populationsstronglypreferred.
• Familiarity with HEDIS measures, risk adjustment, and population health management.
• Excellent interpersonal and communication skills with a team-based, patient-centered approach.
• Proficiencyin the use of electronic medical record (EMR/EHR) systems and documentation workflows.

Core Competencies: 

• Clinical Excellence: Provides safe, evidence-based, and patient-centered care.
• Population Health Management:Demonstratesaccountability for quality,utilization, and outcomes within a defined patient panel.
• Quality & Compliance: Applies HEDIS metrics and organizational standards to meet or exceed performance targets.
• Team Collaboration: Works effectively with physicians, care coordination staff, and the Quality Assurance team to ensure continuity and quality of care.
• Communication: Engages patients and families with empathy, respect, and clarity to foster trust and adherence.
• Resource Stewardship: Promotes cost-effective care aligned with Nuvia’s value-basedobjectives.

Core Values and Behaviors: 

• Integrity – Acts ethically, honestly, and consistently in all interactions with patients, families, and colleagues.
• Compassion – Demonstrates empathy and kindness while respecting the dignity and individuality of each patient.
• Accountability – Takes ownership of clinical decisions, patient outcomes, and performance metrics.
• Respect – Values diverse perspectives and promotes an inclusive, culturally sensitive environment.
• Excellence – Strives for superior clinical and operational performance in alignment with Nuvia’s value-based mission.