HEDIS: A Lucrative Option for Nurses

Nursing can be a tough gig: being on your feet for 12-hour shifts, working nights and weekends, tending to patients’ endless needs. With a high-stress, physically demanding job like this, burnout is to be expected.

If you love being in healthcare but need a break from the long shifts and taxing work environment, it may be time to consider HEDIS nursing. According to Lightcast, job postings for nurses (RN, LPN/LVN, and Nurse Practitioners) with HEDIS skills in their job description have increased by 35% since February 2020. Besides high demand, what are the benefits of pursuing this unique career path for nurses?

In this Q&A we discuss the benefits of HEDIS nursing, a lucrative and unique career path for nurses.

Q: What is HEDIS?

A: HEDIS stands for the Healthcare Effectiveness Data and Information Set. It’s a group of performance metrics used in healthcare to run annual audits of insurance companies. The goal is to compare the healthcare being offered to patients for different ailments, from strokes and diabetes to broken bones and osteoporosis.

HEDIS is made up of 90 different metrics used to score the quality of healthcare offered to patients by insurance companies. Patients can use these scores to help decide which insurance provider is best equipped to meet their and their family’s needs.

Health insurance companies can also use HEDIS scores to determine where they can improve the quality of treatments and services they provide.

Q: What do HEDIS nurses do?

A: HEDIS nurses review medical records and data to determine the quality of healthcare being provided to patients. With this information, HEDIS nurses can help determine where certain insurance providers can improve the quality of care they provide.

Q: Who goes into HEDIS nursing? What skills are needed?

A: Usually, HEDIS nurses are registered nurses (RNs) or licensed practical nurses (LPNs) in the middle or later stages of their careers. Both RNs and LPNs are authorized to review confidential medical records and can understand the complex jargon that tends to come with them. They can look at these medical records and understand what ailment a patient had and how it was treated.

Besides being medically literate, HEDIS nurses should also have experience with computers and data analysis. This experience helps them audit and extract important information and data from electronic medical records.

Because HEDIS season runs from January through May, HEDIS nurses need to be able to work on a very tight timeline. Strong time management skills are definitely a plus.

Q: Why be a HEDIS nurse?

A: There are a lot of reasons why traditional nurses would want to consider a HEDIS position. For one, companies are willing to pay competitively for HEDIS nurses because of their high demand and niche skill set. HEDIS work is also a great way to broaden your knowledge in different areas of healthcare, as HEDIS metrics span across the healthcare industry.

Because HEDIS contains 90 different metrics to measure across healthcare, HEDIS work can allow nurses to learn about different areas of healthcare they don’t usually get exposure to.

HEDIS work is also a great option for nurses looking to avoid the burnout that can come with traditional nursing positions. HEDIS nursing is a 9-5 office job, so these nurses don’t have to work 10–12-hour shifts. Instead, they can enjoy nights, weekends, and holidays while knowing that they’re making a difference in the healthcare space.

Q: Why are HEDIS nurse positions seasonal? What happens when the season ends?

A: HEDIS positions are seasonal because of the audit process that health insurance companies follow. While annual audits run from January to May, staffing companies like Actalent begin the hiring process months prior. Recruiting for HEDIS nurse roles can start as early as September. Interviews occur in November and final job offers are made by early December at the latest.

After finishing their HEDIS work, nurses really have a huge number of options available to them. Unemployment rates in healthcare, especially nurses, are incredibly low, indicating that nurses aren’t having trouble finding their next job. Some nurses return to work on a flexible basis and move between different hospitals depending on the day and what is needed. Others choose to take a full-time position with a health insurance provider instead of returning to traditional nursing. And then there are some who are brought on to do HEDIS work year-round.

HEDIS gives nurses a foothold in the health insurance industry while also giving them a break from the high-stress, physically demanding work of an RN or LPN. HEDIS nurses gain experience that helps qualify them for future roles in case management, utilization review, disease management, and even behavioral health.

Interested in a career change? Check out relevant jobs with Actalent.

^{Originally published August 31, 2018}