Lead Quality Review and Audit Coordinator, RN/LPN

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

📋 Description

• Assess the requirements for HEDIS medical record reviews, data validation, and quality auditing tasks before the production release.

• Formulate and implement audit strategies.

• Perform comprehensive reviews of medical records and HEDIS data.

• Detect discrepancies and document the findings.

• Ensure compliance with HEDIS guidelines and quality standards.

• Collaborate with internal stakeholders to research, investigate, and resolve data-related issues.

• Provide precise updates and reports on audit status.

• Support Star Rating performance through ongoing quality and improvement initiatives.

• Work autonomously, manage multiple priorities, and achieve productivity and accuracy metrics in a remote setting.

⛳️ Requirements

• A Bachelor’s degree in technology or business administration along with 2 years of testing experience OR 4 years of testing experience.

• Strong verbal, written, and interpersonal communication skills, including the ability to collaborate effectively in teams.

• Analytical and problem-solving abilities, combined with a sense of initiative and accountability.

• Familiarity with testing methodologies and the Software Development Life Cycle.

• Experience with automated testing tools.

• Current, unrestricted RN or LPN license is preferred.

• Prior experience in performing HEDIS medical record reviews, abstraction, auditing, and data validation is preferred.

• Strong understanding of HEDIS measures, quality improvement initiatives, and Star Ratings programs is preferred.

• Experience with electronic medical records (EMR) and reviewing clinical documentation for compliance and quality reporting is preferred.

• Familiarity with Arcadia or similar population health and quality management platforms is preferred.

• Advanced skills in Microsoft Excel, including data review, analysis, and reporting, are preferred.

• Ability to work independently in a remote, self-directed environment is preferred.

• Capacity to maintain a high level of accuracy in a metric-driven environment, including meeting established quality standards, is preferred.

• Strong attention to detail with experience in high-volume audit or quality review tasks is preferred.

• Ability to handle competing priorities and meet deadlines during peak HEDIS audit periods is preferred.

• Experience interpreting and applying evolving regulatory, quality, or HEDIS guidelines is preferred.

• Experience in supporting healthcare quality, population health, care management, provider engagement, or quality improvement programs is preferred.

• Successful completion of drug screening may be required.

• Must work remotely from within the continental United States, excluding California, New York, Alaska, and Hawaii.

🏝️ Benefits

• Tailored development plans and opportunities for professional growth.

• Health and wellness benefits.

• 401(k) savings plan.

• Pension plan.

• Paid time off.

• Paid parental leave.

• Disability insurance.

• Supplemental life insurance.

• Employee assistance program.

• Paid holidays.

• Tuition reimbursement.

• Annual incentive bonus plan.

• Additional incentives.