Updated: Published
I recently read a lot about QI/QA on this forum, and this nursing specialty sounds so interesting. I really want to get away from the bedside care nursing. My friend recently got a job with healthcare insurance as a Utilization Review Nurse ( or something like that) and is very happy; she will also get full training. I just saw an ad in my area for Hedis Nurse Reviewer and Utilization Review Nurse; they want acute care experience ( which I do - 6 years of medical-surgical), and Hedi's knowledge is a preferred/big plus. I don't know anything about Hedis and am not sure if they will be willing to train me appropriately. I'm so confused if I should have applied for these jobs. The job of Hedis Nurse Reviewer involves traveling to Md/hospital offices, and I don't understand quite what I would be doing exactly.
Of those of you who work in that field- do you recommend reading certain books or getting specific certifications for these types of jobs? How do I learn Hedis before the job?
Hi Lisa,
I know about ACO, and I have worked on this quality program two years in a row. It even shares some of the same measures as HEDIS, like HTN, Diabetes, Preventive Measure Screenings, and Heart Failure.
The program is similar to HEDIS, except you will be abstracting for CMS patients instead of private insurance companies. The good thing is if you have no experience abstracting, this is a good way to gain experience.
The downside is the program has a shorter timeline than HEDIS and, from my experience, does not pay as much.
If you do this, it can lead to other things. I am not even a nurse, but I have done clinical data abstraction for nine years working with quality measures and oncology.
I am hoping 2018 will be the year I work with the HEDIS program. Let me know how you are working on the ACO program.
Not sure where you are, but MediSys is currently looking for nurses to do HEDISYS in Pennsylvania, about 45 mins from Philadelphia. I believe they will train for free.
HEDIS/MRR POSITIONS KING OF PRUSSIA | Medisys Solutions, LLC
If interested, please send me a private message, and I will directly connect you with the office for a quicker response.
Lori C
3 Posts
Could you forward me information regarding your company and training? Or contact information if possible?