What are the responsibilities and job description for the HEDIS Quality Reviewer position at Pride Health?
Job Title: HEDIS Quality Reviewer
Location: New York, NY 10004
Job Type: Contract (3 Months – Extension Based on Performance)
Work Schedule: 8 hours/day, 5 days/week
Shift: 9:00 AM – 5:00 PM
Work Model: In-person / Hybrid (Field-based as required)
Pay Rate: $68 – $70/hr (W2)
Job Description
We are seeking an experienced HEDIS Quality Reviewer to support quality improvement initiatives through comprehensive medical record review and clinical audits. This role plays a key part in ensuring compliance with HEDIS, QARR, and STAR measures while supporting provider engagement and data integrity across the continuum of care.
Key Responsibilities
- Maintain up-to-date knowledge of HEDIS, QARR, and STAR specifications
- Conduct clinical audits using EMR systems, paper medical records, and on-site provider visits
- Distribute medical record requests and schedule appointments with provider offices to meet regulatory timelines
- Review and abstract medical records to measure compliance with preventive health and quality standards
- Identify, track, and report gaps in care and variations from standards; support quality improvement interventions
- Accurately enter clinical quality findings into designated systems following documentation standards
- Support quality improvement projects and collaborate with internal and cross-functional teams
- Provide education and guidance to providers and office staff to improve documentation and quality outcomes
- Facilitate retrieval of electronic and paper medical records in collaboration with provider groups and field teams
- Participate in annual HEDIS and QARR hybrid medical record review projects
- Support and guide temporary staff; serve as a final reviewer for HEDIS/QARR records when required
Required Qualifications
- Clinical background such as RN, LPN, Health Educator, LMSW/LCSW, Medical Assistant, or Foreign Medical Graduate (FMG)
- Minimum 2 years of HEDIS/QARR medical record review experience
- Experience in managed care, health plan, or provider office settings
- Strong ability to read, interpret, and audit medical records against quality standards
- Knowledge of ICD-10 and CPT codes preferred
- Proficiency with EMR systems (e.g., EPIC, Quadramed)
- Strong computer skills including Microsoft Word, Excel, PowerPoint, and Access
- Ability to travel within the unit service area
Preferred Qualifications
- 3–5 years of Quality Improvement experience in healthcare or managed care environments
- Prior participation in annual HEDIS/QARR hybrid reviews
Education
- High School Diploma or GED required
- Clinical education background strongly preferred
Pride Health offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts with preferred vendors.
Salary : $68 - $70