Job Description

Join to apply for the HEDIS Quality Improvement Nurse role at Community Health Plan of Washington 1 day ago Be among the first 25 applicants Join to apply for the HEDIS Quality Improvement Nurse role at Community Health Plan of Washington **Working Each Day to Make a Difference** At Community Health Plan of Washington, we're driven by our belief that everyone deserves access to quality health care. More than 25 years ago, we made a commitment to improve the health of our communities by making quality health care accessible to all Washington state residents. We continue that pledge today by providing affordable comprehensive coverage to more than 315,000 individuals and families throughout the state. We are a local not-for-profit health plan in Washington State. We are committed to keeping Washington families healthy. We connect our communities to the health resources they need. We provide access to high-quality care for our members. We connect and empower our members through technology. The Community Health Centers we partner with strive to support members with a comprehensive mix of medical resources in one convenient location. Our partnerships with Community Health Centers and our extended provider network help us improve the health care delivery system. To learn more about how you can make a difference working at Community Health Plan of Washington, visit**["nofollow"}.

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• *HEDIS Quality Improvement Nurse**
• *[About the role:]{.underline}**

The HEDIS Quality Improvement Nurse is responsible for performing medical record review audits and analysis for regulatory National Committee for Quality Assurance (NCQA) and Centers for Medicare & Medicaid Services (CMS) audits. This role supports assisting the Manager with developing provider audit reports, provider education, identifying opportunities for process improvement, performs overread and peer review of other team member output.

• *[Qualifications:]{.underline}**
• *[Education & Prior Related Experience:]{.underline}**

Are a Licensed Registered Nurse (RN) or License Practical Nurse (LPN). Have a minimum of five (5) years combined experience performing NCQA, Health Effectiveness Data and Information Set (HEDIS) and CMS Medicare Star measure medical record and coding review AND conducting documentation and coding Have experience with Microsoft Office Suite (Word, Excel, Outlook, and Internet Explorer) and Adobe Acrobat, including comfort with pivot tables at a minimum. Experience with SharePoint, Confluence, and Smartsheet is advantageous. Have bachelor's degree in nursing or an equivalent combination of education and highly relevant experience preferred. Have knowledge and experience with NLP, computer assisted medical record review and coding applications (preferred). Have an applied understanding of principles of reimbursement-based CMS Medicare Stars and State Value Base program experience preferred. **[Essential functions and Roles and Responsibilities]{.underline}[:]{.underline}** Support updating and maintaining CHPW HEDIS medical record review and coding guidelines to reflect changes of the NCQA HEDIS Technical Specification and Medicare Part C & D Star Technical Notes. Interpret changes and support modifying CHPW policies in coordination with HEDIS Performance Measurement Manager and HEDIS Program Manager. Keep current on regulatory, medical record documentation and coding issues/best practices including NCQA Guidelines for Medical Record Documentation, Coding and Reporting. Present findings via verbal and written updates to internal audiences including peer to peer, department leadership reporting, provider and clinical teams, and vendor support teams. Update and distribute provider feedback reports to HEDIS Performance Manager as needed for identifying provider performance trends and participate in crea Seniority level Seniority level Mid-Senior level Employment type Employment type Full-time Job function Job function Health Care Provider Industries Insurance Referrals increase your chances of interviewing at Community Health Plan of Washington by 2x Sign in to set job alerts for “Nurse” roles. Seattle, WA $80,000.00-$135,000.00 4 months ago Seattle, WA $80,000.00-$135,000.00 4 months ago RN / REGISTERED NURSE NWH OUTPATIENT SURGERY 50% FTE Seattle, WA $75,000.00-$135,000.00 1 month ago Registered Nurse - Ambulatory Coordinator Seattle, WA $77,500.00-$135,000.00 6 months ago Registered Nurse RN Home Health $10,000 Bonus Seattle, WA $75,000.00-$135,000.00 3 months ago RN / REGISTERED NURSE - ENDOSCOPY (100% FTE, DAYS) Seattle, WA $7,596.00-$13,798.00 3 weeks ago RN / REGISTERED NURSE - INTERNATIONAL MEDICINE CLINIC (PART-TIME, 50% FTE) Seattle, WA $7,596.00-$13,798.00 2 weeks ago Registered Nurse - RN / Clinic (No Specific Specialty) - CLINIC Issaquah, WA $85,000.00-$135,000.00 1 month ago Registered Nurse - RN / Clinic (No Specific Specialty) - CLINIC Renton, WA $2,241.06-$2,241.06 2 weeks ago We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI. #J-18808-Ljbffr Community Health Plan of Washington

Job Tags

Full time, Part time, Work at office, Local area,

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