What Is a Hedis Review Nurse and How to Become One
Table of Contents
What Is a HEDIS Review Nurse?
As a HEDIS review nurse, you check medical records for completeness and accuracy according to the Healthcare Effectiveness Data and Information Set (HEDIS) performance measures. Your responsibilities are to measure and to evaluate the performance of medical facilities and the quality of care that patients receive according to HEDIS. Your job duties are to create HEDIS reports, including incorrect or missing documentation, and to submit them to insurance health plans, accreditation commissions, and other organizations. Data analysis, attention to detail, and communication skills are essential for these jobs. Qualifications for a career as a HEDIS review nurse include nursing credentials and training in HEDIS measures.
How to Become a HEDIS Review Nurse
Healthcare Effectiveness Data and Information Set (HEDIS) is a performance measure that health insurance companies use to determine the quality of particular hospitals or healthcare practices. To become a HEDIS review nurse and assist in the annual audit of HEDIS performance indicators, you need a strong medical background and computer literacy. You must be a registered nurse (RN) or a licensed practical nurse (LPN) with several years of experience. Prior work experience with case management or utilization review is beneficial.
