HEDIS Improvement Nurse

Found in: Lensa US P 2 C2 - 2 weeks ago

Rancho Cucamonga, United States Alura Workforce Solutions Full time

Position

HEDIS Improvement Registered Nurse

Description

Under the direction of the Supervisor, Clinical Quality Improvement, the HEDIS Improvement Nurse provides support to the Supervisor, Clinical Quality Improvement and company departments on HEDIS improvement related issues, serving as a resource for internal and external customers. Is able to interpret clinical data for QI-related studies for medical management. This position maintains a working knowledge of the current medical management system (MedHOK), business processes and workflows. Maintains summarized information for Quality Systems related to modified and new regulatory requirements for medical management from DHCS, DMHC and CMS.

1. Responsible for understanding current HEDIS technical specifications with the ability to interpret changes and clarifications accurately.

2. Acts as a liaison between the QI/HEDIS department and other departments, practitioners, and providers to ensure basic understanding of HEDIS projects/issues.

3. Responsible for participating in the development, research, and implementation of HEDIS improvement activities, as directed.

4. Trains other departments on HEDIS related measures, as needed.

5. Responsible for assisting the PMI Manager with the HEDIS Improvement Committee (HIC) agenda, maintaining the Action Tracking log, writing HIC minutes, monitoring attendance, ensuring follow up activities are addressed by all departments and submitted timely for the next HIC.

6. Reviews and performs quality assurance checks of supplemental data files (both manual and digital) throughout the year, ensuring 100% accuracy.

7. Participates in medical record abstraction and accuracy validations (overreads) for HEDIS hybrid pursuit, maintaining subject matter expert status to assist other nurse reviewers.

8. Maintains tracking system for regulatory changes to ensure QS management is apprised of significant modifications required.

9. Responsible for maintaining knowledge of various other data sources utilized by QS to assist with regulatory compliance.

10. Maintains a working knowledge of the current medical management system (MedHOK) and how information is stored and retrieved.

11. Able to troubleshoot medical management report requests to determine user needs and objectives, working with users to correctly identify criteria.

12. Participates in analysis, interpretation, and translation of complex clinical data, issues, trends, and relationships into effective strategies and action plans for medical management.

13. Supports and educates the QI/HEDIS Coordinator in CRM activities, HEDIS data entry, and all other applicable HEDIS related activities.

14. Possess basic knowledge of Microsoft Access to look up Member data for purposes of verifying clinical services needed or received. This helps ensure timely processing of Oracle CRM tasks.

15. Establishes and maintains effective working relationships with others throughout the organization as well as external customers.

16. Responsible for managing assigned projects and effectively communicating with PMI Manager if any project deadlines will not be met, well in advance of the project due date.

17. Demonstrate a commitment to incorporate LEAN principles into daily work.

Requirements

Three (3) or more years of any individual or combined experience in quality assurance, utilization management, case management, and/or health care informatics is required.

Experience preferably in an HMO or managed care setting.

Associates in Nursing from an accredited institution required.

Bachelor's in Nursing from an accredited institution preferred.

Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN

Working knowledge of NCQA HEDIS technical specifications, medical terminology, and health plan processes preferred.

Data analysis, word processing, spread sheet (Excel) and some database capabilities. Excellent interpersonal/communication skills.

Additional Information

Hybrid position

Monday and Friday working from home/ remote

Tuesday- Thursday working onsite

INDH

  • HEDIS Improvement Nurse 24-00377

    1 week ago

    Rancho Cucamonga, United States Alura Workforce Solutions Full time

    Position HEDIS Improvement Registered Nurse Description Under the direction of the Supervisor, Clinical Quality Improvement, the HEDIS Improvement Nurse provides support to the Supervisor, Clinical Quality Improvement and company departments on HEDIS improvement related issues, serving as a resource for internal and external customers. Is able to...

  • Quality Improvement Program Manager

    5 days ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    Overview: What you can expect! Find joy in serving others with IEHP! We welcome you to join us in healing and inspiring the human spirit and to pivot from a job opportunity to an authentic experience! Under the direction of department leadership, the Quality Improvement Program Manager will drive quality improvement initiatives across the continuum of care...

  • Physician / Administration / California / Permanent / Health Plan Medical Director Job

    2 days ago

    Rancho Cucamonga, United States IEHP Full time

    1. Develop and implement medical policy for utilization management activities and functions, including benefit manual statement, policies and procedures, and Utilization Management Subcommittee Guidelines. Provide training and consultation for both internal staff and medical personnel of the Plan regarding policy application.2. Provide direction and control...

  • Quality Review Nurse, RN 24-00340

    1 week ago

    Rancho Cucamonga, United States Alura Workforce Solutions Full time

    Position Quality Review Nurse, RN Description Reporting to the Manager of Provider Quality Oversight, the Provider Quality Review Nurse, RN is responsible for: - Receive and research all PQI and QR cases as assigned, provide a summary and recommendations to the Medical Director of case assignments. - Effectuate all action items as determined by the...

  • Regional QAPI Director

    Found in: beBee jobs US - 6 days ago

    Rancho Cucamonga, California, United States Charter Healthcare Full time

    POSITION SUMMARYThe Regional QAPI Director for Hospice Division coordinates and implements clinical strategies and provide leadership development for clinical team members on quality analysis, direction, and performance improvement related to clinical care. They provide overall guidance and support for regulatory and compliance matters on delivery, service,...

  • Veterinary Technician Externship

    Found in: Lensa US P 2 C2 - 2 weeks ago

    Rancho Cucamonga, United States Terra Vista Animal Hospital Full time

    Description Position at Terra Vista Animal Hospital UVC Veterinary Technology Externship Are you a passionate veterinary technology student eager to gain hands-on clinical experience and pave the way to a successful career? Look no further! United Veterinary Care's BRIDGE Veterinary Technology Externships offer a transformative opportunity like no other....

  • Psychiatric Technician

    1 week ago

    Rancho Cucamonga, United States Liberty Healthcare Corporation Full time

    Job Description Psychiatric Technicians are encouraged to consider an available position with Liberty Healthcare's mental health program at the West Valley Detention Center. Liberty Healthcare operates a specialized mental health program within the West Valley Detention Center - a San Bernardino County jail located in Rancho Cucamonga. This program...

  • Manager, UM Regulatory

    6 days ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    What you can expect!Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!The Manager, UM Regulatory & Compliance - CCA is responsible for the coordination, implementation, and oversight of the IEHP’s overall Utilization Management...

  • Manager, UM Regulatory

    Found in: beBee S US - 2 weeks ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    What you can expect!Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!The Manager, UM Regulatory & Compliance - CCA is responsible for the coordination, implementation, and oversight of the IEHP’s overall Utilization Management...

  • Manager, UM Regulatory

    7 days ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    What you can expect!Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!The Manager, UM Regulatory & Compliance - CCA is responsible for the coordination, implementation, and oversight of the IEHP’s overall Utilization Management...

  • Psychiatric Technician

    Found in: Lensa US P 2 C2 - 2 weeks ago

    Rancho Cucamonga, United States Liberty Healthcare Full time

    Psychiatric Technicians are encouraged to consider an available position with Liberty Healthcare's mental health program at the West Valley Detention Center. Liberty Healthcare operates a specialized mental health program within the West Valley Detention Center - a San Bernardino County jail located in Rancho Cucamonga. This program provides high quality...

  • Manager, ITC Quality

    Found in: Resume Library US A2 - 1 week ago

    Rancho Cucamonga, California, United States Inland Empire Health Plan Full time

    Overview: What you can expect!    Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!   The Manager, Integrated Transitional Care Manager Quality & Training reports to the Integrated Transitional care Director and is...

  • Director, Hospital Relations

    Found in: Resume Library US A2 - 6 days ago

    Rancho Cucamonga, California, United States Inland Empire Health Plan Full time

    Overview: What you can expect!    Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!   This position supports department Senior Leadership in leading a team of operational, process, and clinical improvement professionals...

  • Assistant Director of Nursing

    4 days ago

    Rio Rancho, United States Santa Fe Care Center Full time

    Assists in organizing and administering the department of nursing while providing quality nursing care and assumes responsibilities delegated by the Director of Nursing. This is a salary position. Esential Functions of Position: Assists in supervising the assignment and scheduling of nursing staff to meet resident needs Provides nursing care on shift when...

  • Assistant Director of Nursing

    3 days ago

    Rio Rancho, United States CareerBuilder Full time

    Assists in organizing and administering the department of nursing while providing quality nursing care and assumes responsibilities delegated by the Director of Nursing. This is a salary position. Esential Functions of Position: Assists in supervising the assignment and scheduling of nursing staff to meet resident needs Provides nursing care on shift when...

  • Registered Nurse

    2 weeks ago

    Rio Rancho, United States University of New Mexico - Hospitals Full time

    Relocation Reimbursement available Department: Inpatient 5th Floor - SRMC FTE: 0.90 Full Time Shift: Days Position Summary: Independently promote and restore patients' health through direct nursing care to assigned patients within the nursing process; collaborate with physicians and multidisciplinary team members. Devotes a majority of work time to...

  • Registered Nurse

    2 weeks ago

    Rio Rancho, United States University of New Mexico - Hospitals Full time

    Relocation Reimbursement available Department: PreOp/PACU - SRMC FTE: 1.00 Full Time Shift: Days Position Summary: Independently promote and restore patients' health through direct nursing care to assigned patients within the nursing process; collaborate with physicians and multidisciplinary team members. Devotes a majority of work time to supervisory...

  • Registered Nurse

    3 days ago

    RIO RANCHO, United States University of New Mexico - Hospitals Full time

    Relocation Reimbursement availableDepartment: PreOp/PACU - SRMCFTE: 0.60Part TimeShift: DaysPosition Summary:Independently promote and restore patients' health through direct nursing care to assigned patients within the nursing process; collaborate with physicians and multidisciplinary team members. Work under the general nursing process while using...

  • Charge Nurse

    4 days ago

    rio rancho, United States University of New Mexico - Hospitals Full time

    Sign-on Bonus and Relocation Reimbursement available!Receive 17% weekday nights, 26% weekend nights, or 15% weekend day shift differentials!Department: InPatient 4th Floor - SRMCFTE: 0.90Full TimeShift: DaysPosition Summary:Independently promote and restore patients' health through direct nursing care to assigned patients within the nursing process;...

  • Registered Nurse Utilization Supervisor

    5 days ago

    Rancho Cordova, United States JobRialto Full time

    Job DescriptionMinimum Qualifications: RN CA License required - Graduate of an accredited school of nursing. Five or more year's clinical experience is required.Three to five years Utilization Management experience required.One to three years charge/lead/supervisory/management experience required.Ability to demonstrate leadership and management skills.7...