How to Become a HEDIS Nurse
If you’re looking for a non-bedside nursing job, you might be wondering, What is the role of a HEDIS nurse? A Healthcare Effectiveness Data and Information Set (HEDIS) is a tool that insurance providers use to measure care quality. Instead of having traditional bedside responsibilities, HEDIS nurses focus on chart reviews, documentation audits, and ensuring that clinical data accurately reflects the care patients receive. Working in HEDIS nursing requires a nursing license and an understanding of quality-improvement data.
HEDIS is a performance-measurement system created by the National Committee for Quality Assurance (NCQA). It’s designed to evaluate how well health plans and healthcare organizations provide care to patients. HEDIS includes a range of health issues, including blood pressure control, diabetes care, breast cancer screenings, and much more.
What Is HEDIS Nursing?
So, what does a HEDIS RN do? Nurses who work with HEDIS play a key role in evaluating the quality of care delivered by health plans and providers. They primarily work with data abstraction, which means reviewing medical records, identifying whether specific quality measures were met, and ensuring that documentation matches the care delivered. They may also reach out to providers or patients to close data gaps, collaborate with quality-improvement teams, and help health plans prepare for audits.
HEDIS nursing is highly administrative and analytical, often seasonal, and sometimes remote. You might be wondering, What is a typical day for a HEDIS nurse? A day in this role might include any of the following tasks:
- Combing through charts to determine the quality of care a patient received at a specific healthcare facility
- Creating reports integrating data from a range of sources
- Preparing HEDIS compliance reports
- Travelling to facilities to perform in-person audits
- Documenting findings in HEDIS databases
The HEDIS system is used year-round, but because many HEDIS nursing roles focus on preparing for yearly audits, opportunities are often seasonal, beginning in December. Nurses might pick up HEDIS roles as a side-hustle or as a supplement between travel nursing contracts.
The Pros and Cons of Working in HEDIS Nursing
| Potential Benefits | Potential Drawbacks |
|---|---|
| Flexible work structure: Many HEDIS positions are remote, seasonal, or hybrid roles, which can offer better work-life balance than other positions.
Interprofessional collaboration: Nurses in this role work closely with care providers, care coordinators, and quality teams. Professional growth: HEDIS nurses gain expertise in population health, quality improvement, and healthcare analytics. |
Repetitive tasks: Reviewing charts and tracking metrics can become repetitive and feel less impactful than patient-facing roles.
Seasonality: The structure of this work may leave nurses with fewer opportunities during some parts of the year. Data-intensive: The role requires meticulous chart reviews, data entry, and reporting, which may not be a good fit for everyone. |
How to Become a HEDIS Nurse: 4 Steps
First, you’ll need to gain a nursing license as either a Licensed Practical Nurse (LPN) or Registered Nurse (RN). Learn more with the steps below:
Step 1: Attend Nursing School
Start by completing a pre-licensure nursing program. LPNs will complete a diploma program of about a year, while RNs have two degree options: an Associate Degree in Nursing (ADN) or a Bachelor of Science in Nursing (BSN). While the ADN is a shorter degree path, a BSN might open you up to more opportunities later on. Learn more about comparing nursing degrees.
Step 2: Become a Licensed Nurse
Once you graduate, you’ll need to become licensed to practice. The National Council Licensure Exam (NCLEX) is the licensure exam for LPNs and RNs; LPNs take the NCLEX-PN, and RNs take the NCLEX-RN. Licensure ensures you meet the professional standards and can practice safely. Once you pass, there may be additional licensure requirements that are specific to your state nursing board.
Step 3: Gain Experience
HEDIS nurses tend to have prior clinical experience. As a new graduate nurse, you might want to seek out roles where you can deepen your critical thinking and clinical skills. Consider acute care roles in the following areas:
Gaining experience will also help you become familiar with electronic health records (EHRs), which you’ll need to be confident with in order to work as a HEDIS nurse. Consider pursuing chart review or auditing experience, and try to get familiar with as many EHR systems as possible.
Step 4: Apply for HEDIS Roles for Nurses
Once you’ve gotten some experience under your belt, look for HEDIS nursing positions at health plans, insurance companies, and quality-improvement organizations. Follow our nursing resume tips to align your application with the job description, and don’t forget to prepare for interviews by reviewing common nursing interview questions.
Step 5 (Optional): Become HEDIS Certified
Becoming a certified HEDIS compliance officer can help you deepen your data analysis skills and strengthen your resume. To pursue this credential, a licensed health plan must sponsor your application. Certified compliance officers are the only people who can complete HEDIS compliance audits, so it’s a great credential if you want to boost your job responsibilities.
To pursue this credential, you’ll create a MyNCQA Account and submit an application and complete a two-day exam. Once you’ve earned this credential, it needs to be renewed every two years.
Do you have to be a nurse to be HEDIS certified? No, but nurses in this area may earn more and take on more responsibilities than non-nurses.
How Much Do HEDIS Nurses Make?
The median salary for this role is $72,000 per year. Your pay will vary depending on your location, schedule, experience, and certifications.
You might have a better chance of landing a high-earning role if you’re willing to relocate. Check out nursing jobs in the states with the highest average pay for RNs:
Find Remote Roles for Nursing Professionals
Want to see more remote opportunities like becoming a HEDIS nurse? IntelyCare has roles that fit your life, and we’re excited to share them with you. We can send you tailored jobs that align with your schedule, location, and specialty. Learn more when you sign up for personalized job notifications.