What Is HEDIS Nursing? (With Job Details)

Nursing can be a tough gig — being on your feet for 12-hour shifts, working nights and weekends, dealing with patients’ endless needs. With such a high-stress, physically demanding job, it can easily make you feel burned out

If you’d like to get off the nursing floor, there’s an intriguing career option you may not have heard of: HEDIS nursing.

Instead of working directly with patients, HEDIS nurses review medical records to determine how well healthcare providers are caring for their patients. Some experienced nurses transition into this role looking for a change of pace because it’s well-paying seasonal work in an office setting.

To learn more about this little-known health care job, we spoke with Mike Pendergast, healthcare account manager who works closely with HEDIS nurses.

The Healthcare Effectiveness Data Information Set (HEDIS) is a construct of guidelines used to measure healthcare performance and service. Developed by the National Committee for Quality Assurance (NCQA), HEDIS is used in over 90 percent of U.S. healthcare plans to establish standardized indices.

How Do I Get A Job Doing HEDIS If I’ve Never Done HEDIS?

What does a HEDIS nurse do?

HEDIS nurses focus solely on using HEDIS measuring criteria to review health plans in accordance with healthcare facility practices and patient experiences. Here are some specific examples of the types of job responsibilities HEDIS nurses have:

What is HEDIS nursing?

HEDIS nursing, or Healthcare Effectiveness Data and Information Set Nursing, is a type of non-clinical nursing where nursing professionals use healthcare data and software to evaluate medical forms or patient records to compare items like patient care to a patients health plans to make sure it meets a patients care needs. The National Commission for Quality Assurance (NCQA) came up with HEDIS to evaluate its health plans and other healthcare providers also adopted HEDIS measures to evaluate the effectiveness of their health plans. According to ncqa.org, HEDIS measures focus on a few key areas including:

Skills for HEDIS nurses

HEDIS nurses can benefit from a variety of interpersonal and technical skills. These are some examples of beneficial skills for HEDIS nurses:

How to become a HEDIS nurse

Review these steps to determine how to become a HEDIS nurse:

1. Earn a nursing degree

The first step to becoming a HEDIS nurse is to attend either a two-year associate degree in nursing or a four-year bachelors degree in nursing. Both programs qualify you to take the national licensing examination for registered nurses and pursue registered nursing roles in hospitals, healthcare clinics and care homes.

2. Complete a few years of work experience in healthcare

To qualify for a HEDIS nursing role, you also need to work in a registered nursing role for a few years to gain clinical experience in a healthcare setting. During this time, you can advance your knowledge of patient care topics, healthcare policies, insurance coverage options and medical records.

3. Consider earning certifications in areas like medical coding

This is an optional step, but earning a certification in medical billing and coding can help you prepare for your role as a HEDIS nurse. This is because you may need to complete medical coding activities to sort through and organize medical data.

4. Request and submit an application to the NCQA

You can request an application through the NCQA website. This requires you to make an account. Then, you can receive information about applying and requirements. Once you receive an application, you need to find a sponsor (former or current employer) to act as a reference. You may also need to include a resume and cover letter to showcase your skills.

5. Study materials upon application approval

Once the NCQA approves your application, you receive access to different resources and handbooks to study with prior to taking the exam.

6. Take and pass the HEDIS Compliance Audit™ Exam

The NCQA typically have exam times twice a year and it typically takes two days to go through the process. On the first day, you get an in-depth review of the topics covered and on the second day, you take the exam, which takes around four hours to complete.

7. Renew your certification each year

Once you earn your HEDIS certification, you need to renew it each year in order to continue your work as a HEDIS nurse.

FAQ

What is HEDIS and why is it important?

HEDIS is a comprehensive set of standardized performance measures designed to provide purchasers and consumers with the information they need for reliable comparison of health plan performance. HEDIS Measures relate to many significant public health issues, such as cancer, heart disease, smoking, asthma, and diabetes.

What is considered HEDIS experience?

To qualify for a HEDIS nursing role, you also need to work in a registered nursing role for a few years to gain clinical experience in a healthcare setting. During this time, you can advance your knowledge of patient care topics, healthcare policies, insurance coverage options and medical records.

What does a HEDIS reviewer do?

They collect and review data from patient charts and other medical records from hospitals, doctors’ offices and various health care providers to measure and help improve quality.

How does HEDIS work?

HEDIS measures how well health plans give service and care to their members. Here’s how it works: Health plans collect data about their performance on certain services and types of care. For instance, the plan keeps track of how many children get immunizations.

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