HEDIS Improvement Nurse

This is a fully remote position, open to applicants in California.

📋 Description

• Assist the Supervisor of Clinical Quality Improvement and the IEHP departments with issues related to HEDIS improvement.

• Act as a resource for both internal and external stakeholders.

• Analyze clinical data for Quality Improvement-related studies relevant to medical management.

• Keep up-to-date knowledge of current medical management systems, business processes, and workflows.

• Maintain summarized information regarding Quality Systems related to new and modified regulatory requirements from DHCS, DMHC, and CMS.

• Contribute to the goals of the IEHP Quality Program, including HEDIS, CAHPS, and NCQA Accreditation.

⛳️ Requirements

• A minimum of three (3) years of combined experience in quality assurance, utilization management, case management, and/or healthcare informatics.

• Preferred experience in an HMO or managed care environment.

• An Associate's degree in Nursing from an accredited institution is required.

• A Bachelor's degree in Nursing from an accredited institution is preferred.

• Must possess an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN.

• Advanced knowledge of NCQA HEDIS technical specifications, medical terminology, and health plan processes is preferred.

• In-depth understanding of current medical management systems, including how information is stored and accessed.

• Comprehensive knowledge of current HEDIS technical specifications, with the ability to accurately interpret changes and clarifications.

• Basic familiarity with Microsoft Access.

• Proficiency in data analysis and computer applications, including word processing, databases, and spreadsheets.

• Proficient in the Microsoft Office Suite.

• Exceptional interpersonal and communication skills.

• Ability to manage multiple projects and data input tasks.

• Strong problem-solving skills.

• Exceptional attention to detail.

🏝️ Benefits

• Competitive salary.

• On-site state-of-the-art fitness center.

• Medical Insurance that includes Dental and Vision coverage.

• Options for life insurance, short-term, and long-term disability.

• Opportunities for career advancement and professional development.

• Wellness programs that support a healthy work-life balance.

• Flexible Spending Account for Health Care/Childcare expenses.

• CalPERS retirement plans.

• 457(b) retirement option with a contribution match.

• Paid life insurance for employees.

• Pet care insurance.