Hedis Specialist

HEDIS LVN Case Manager / HEDIS Specialist

The HEDIS LVN Case Manager / HEDIS Specialist supports quality programs by focusing on HEDIS and quality gap closure activities rather than traditional episodic case management. In this role, you review and work approximately 2030 medical records or member cases per day, depending on complexity, and ensure that medical record abstraction and data validation are accurate, complete, and compliant with technical specifications. You contribute directly to HEDIS measure performance, regulatory audits, and quality improvement initiatives, helping the organization achieve and maintain high CMS Star Ratings.

Responsibilities

• Review and work an average of 2030 medical records or member cases per day, adjusting for complexity such as multi-measure abstraction, provider outreach, and detailed documentation review.
• Perform accurate and thorough medical record abstraction across various provider EMR systems and paper chart repositories, ensuring all relevant data is captured.
• Validate data to ensure accuracy, completeness, and compliance with HEDIS technical specifications and quality program requirements.
• Support HEDIS and quality gap closure activities by identifying missing or incomplete information and taking appropriate steps to resolve gaps.
• Contribute to departmental workflows by following established processes, suggesting improvements, and supporting the implementation of best practices.
• Assist with preparation and support for regulatory audits related to HEDIS measures and quality performance.
• Participate in and support annual training activities to maintain up-to-date knowledge of HEDIS measures, CMS Star Ratings, and quality program requirements.
• Communicate effectively with internal teams and external providers as needed to clarify documentation, obtain missing information, and ensure accurate reporting.
• Provide clear, constructive feedback related to documentation, workflow, and quality improvement opportunities to help enhance overall program performance.
• Assist with clerical and administrative duties related to quality programs, medical record management, and reporting as assigned.

Essential Skills

• Current and active California Licensed Vocational Nurse (LVN) license.
• Graduate from an accredited school for Vocational Nurses.
• High school diploma or equivalent.
• At least one year of experience with HEDIS/STAR and medical records review.
• At least one year of LVN experience in an acute care or related clinical setting.
• Proficiency with Microsoft Excel, Word, Outlook, and PowerPoint.
• Strong organizational skills to manage high-volume case review and meet productivity expectations.
• Strong written and verbal communication skills to document findings clearly and collaborate with team members and providers.
• Ability to interpret and apply HEDIS technical specifications accurately during medical record abstraction.
• Attention to detail and a high level of accuracy in reviewing and validating clinical documentation.

Additional Skills & Qualifications

• Experience working with multiple electronic medical record (EMR) systems and paper chart repositories.
• Familiarity with CMS Star Ratings and their relationship to HEDIS and quality performance.
• Ability to adapt to varying project types, reporting timelines, and productivity expectations.
• Demonstrated ability to follow and improve departmental workflows and procedures.
• Comfort working in a structured, metrics-driven environment with defined productivity and quality goals.

Work Environment

This is a fully onsite position in an office-based environment, working Monday through Friday from 8:00 a.m. to 5:00 p.m. You will work primarily at a computer reviewing electronic medical records and paper chart repositories, using standard office technology and software such as Microsoft Excel, Word, Outlook, and PowerPoint. The role involves focused, detail-oriented work in a professional clinical office setting. The dress code for this position is scrubs.

Job Type & Location

This is a Contract position based out of Victorville, CA.

Pay and Benefits

The pay range for this position is $27.66 - $29.07/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:

• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

Application Deadline

This position is anticipated to close on Aug 21, 2026.