Quality HEDIS-STAR Nurse - JHP

Number of Positions In Requisition 1 Job Details The STAR-HEDIS Quality Nurse supports Quality Management initiatives by obtaining, reviewing, and abstracting medical record documentation to close care gaps for HEDIS, CMS STAR Ratings, , Patient-Centered Medical Home (PCMH), and Pay-for-Performance (P4P) measures. This role requires advanced experience navigating multiple electronic medical record systems, performing detailed medical record reviews, and accurately abstracting clinical data into quality and care management systems. The nurse functions as an integral member of the Quality Management team, working collaboratively with colleagues and participating provider offices to obtain medical records. This includes electronic retrieval, manual provider outreach, and onsite record collection to support complete and compliant documentation for quality measurement and audits. Job Description The STAR-HEDIS Quality Nurse supports Quality Management initiatives by obtaining, reviewing, and abstracting medical record documentation to close care gaps for HEDIS, CMS STAR Ratings, , Patient-Centered Medical Home (PCMH), and Pay-for-Performance (P4P) measures. This role requires advanced experience navigating multiple electronic medical record systems, performing detailed medical record reviews, and accurately abstracting clinical data into quality and care management systems. The nurse functions as an integral member of the Quality Management team, working collaboratively with colleagues and participating provider offices to obtain medical records. This includes electronic retrieval, manual provider outreach, and onsite record collection to support complete and compliant documentation for quality measurement and audits. Education - Required Associate’s Degree Unencumbered Registered Nurse (RN) license in Pennsylvania, or a multistate RN license through the Nurse Licensure Compact (NLC) or Technical School Diploma Unencumbered Licensed Practical Nurse (LPN) in the Commonwealth of Pennsylvania Education - Preferred Bachelor’s Degree Experience - Required 3 years Quality management, HEDIS abstraction, clinical audit, or managed care Medical record review and abstraction Demonstrated experience navigating multiple EMR systems Prior HEDIS abstraction or chart review experience strongly preferred Knowledge, Skills and Abilities - Required Advanced proficiency navigating electronic medical record (EMR) systems and reviewing clinical documentation Working knowledge of HEDIS and CMS STAR quality measures and the ability to interpret technical specifications and standards Demonstrated attention to detail, data accuracy, and analytical thinking when abstracting and documenting medical record information Effective time management and organizational skills, with the ability to manage shifting priorities and high-volume workloads during HEDIS season Strong written and verbal communication skills, including professional interaction with internal teams and participating provider offices Ability to work independently with minimal supervision in a remote environment while meeting quality, productivity, and compliance standards Proficiency with Microsoft Office applications (Outlook, Word, Excel), Microsoft Teams, and related documentation tools Commitment to maintaining confidentiality, professionalism, and customer service excellence Valid drivers' license, dependable vehicle, and active auto insurance Ability to travel locally to provider offices as needed Ability to perform moderate physical activity, including walking and lifting/carrying up to 10 pounds Knowledge, Skills and Abilities - Preferred Prior experience with HEDIS abstraction, medical record review, or clinical quality reporting in a health plan, vendor, or provider setting Flexibility and adaptability with new systems, workflows, and process changes Licenses and Certifications - Required DL - Driver's License_PA - State of Pennsylvania and RN - Licensed Registered Nurse_PA - State of Pennsylvania or LPN - Licensed Practical Nurse_PA - State of Pennsylvania Additional Qualifications Compliance Statement: Employees must comply with all applicable federal, state, and regulatory requirements related to Medicare Advantage and quality measurement. Completion of required compliance and quality training is a condition of employment Access To Protected Health Information QM, Care Management System, Medical Record Repository System, Salesforce, Natural Language Processing systems, etc. Work Shift Workday Day (United States of America) Worker Sub Type Regular Employee Entity Health Partners Plans, Inc. Primary Location Address 1101 Market, Philadelphia, Pennsylvania, United States of America Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years. Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status. Benefits Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance. For more benefits information, please click here In keeping with Jefferson's Mission, We Improve Lives, it is our goal to recruit, retain, develop and reward highly-qualified employees. If you are enthusiastic, caring and dedicated to service excellence, we invite you to consider joining Jefferson. Jefferson encourages its employees to expand their knowledge and develop their careers through growth opportunities and continuing education. With a long standing history, Jefferson has been advancing the medical field from the heart of Center City Philadelphia for nearly 200 years. Our Mission, We Improve Lives, expands to every corner of the organization. From our weekly farmer’s market, to our new Jefferson Accelerator Zone for innovation, our employees’ passion for the community is evident by the daily gestures towards our patients, students and each other. #J-18808-Ljbffr