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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.

A HEDIS Nurse is fully trained on the performance measures and domains of HEDIS. By using HEDIS to enforce medical record keeping and coding policies, HEDIS Nurses are invaluable in improving facility care quality. HEDIS Nurses are also essential in reporting to physicians and facility managers on whether these policy standards are being met.

Job Responsibilities

  • Evaluate quality improvement outcomes
  • Gather and analyze performance data
  • Review and assess medical records
  • Participate in on-site inspection preparation
  • Conduct facility audits regarding compliance
  • Present findings to Quality Improvement Committee (QIC)

Qualifications and Skills

  • Active RN license
  • Microsoft Office proficiency
  • 1+ years of data collection and/or data entry experience

In order to serve as knowledge experts, HEDIS Nurses must have a developed understanding of the 81 measures of performance for patient care. They must also possess strong interpersonal skills, convey standards, and ensure that facilities understand how to improve or maintain their practices.