Pride Health · 1 month ago
HEDIS Quality Reviewer
NYC Metro Area
Contract
Hybrid
Entry, Mid Level
$68/hr - $70/hr
2+ years expPride Health is seeking an experienced HEDIS Quality Reviewer to support quality improvement initiatives through comprehensive medical record review and clinical audits. This role is essential in ensuring compliance with HEDIS, QARR, and STAR measures while engaging with providers and maintaining data integrity across care processes.
Health CareHuman ResourcesInformation Technology
Hiring Manager
Sumit Singh
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
Qualification
Required
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
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
High School Diploma or GED required
Preferred
3–5 years of Quality Improvement experience in healthcare or managed care environments
Prior participation in annual HEDIS/QARR hybrid reviews
Knowledge of ICD-10 and CPT codes preferred
Clinical education background strongly preferred
Benefits
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
Employee discounts with preferred vendors
Company
Pride Health
Pride Health is a staffing and recruiting company that provides account management and staffing solutions.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Stephanie Barnes
Scheduling Lead PHC/OPWDD
Recent News
2025-11-06
Company data provided by crunchbase