Clinical Quality Research Analyst (HEDIS Registered Nurse)

Health Care Service Corporation; Chicago (IL); Remote; USD 60,000 - 134,000; Full time

Job summary

Join a purpose-driven company dedicated to investing in your professional development. This role involves conducting data collection and abstraction of medical records, ensuring quality performance for managed care products. You'll interact with various stakeholders, audit clinical quality improvement projects, and translate data into actionable insights. If you're a licensed clinician with a passion for quality improvement and data analysis, this is an exciting opportunity to make a significant impact in healthcare while enjoying the flexibility of telecommuting.

Benefits

Health and wellness benefits

401(k) plan

Paid time off

Parental leave

Disability insurance

Life insurance

Employee assistance program

Tuition reimbursement

Qualifications

• 3+ years of clinical practice experience performing HEDIS medical record review.
• Experience in provider training presentation planning and delivery.

Responsibilities

• Conduct data collection and abstraction of medical records for HEDIS projects.
• Audit clinical quality improvement projects and analyze data.

Skills

Data analysis skills

Strong verbal and written communication skills

Problem resolution skills

Ability to adapt to changing priorities

Education

Registered Nurse (RN) license

Clinical practice experience

Tools

Statistical software

Job description

At HCSC, our employees are the cornerstone of our business and the foundation of our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that invests in your professional development.

Job Summary

This position is responsible for conducting data collection and abstraction of medical records for HEDIS and quality projects, including supplemental data collection. The role involves interacting with internal staff, departments, network providers/IPAs to ensure quality performance and results for Blue Cross managed care products. Responsibilities include auditing all aspects of BCBSIL clinical quality improvement projects, evaluating PCP/MG/IPA compliance with clinical guidelines, analyzing data, educating providers on HEDIS measures and gaps in care, translating data into actionable insights, and reporting results to stakeholders.

Required Job Qualifications:

• Registered Nurse (RN) or licensed clinician with current, unrestricted license in Illinois
• Minimum of 3 years of clinical practice experience performing HEDIS medical record review
• Minimum of 3 years of healthcare or managed care experience, including quality improvement or project management
• At least 1 year of HEDIS medical record data abstraction experience
• Data analysis skills, knowledge of statistical software and methods
• Ability to adapt to changing priorities and manage multiple projects
• Strong verbal and written communication skills
• Problem resolution skills with diplomacy and respect
• Experience in provider training presentation planning and delivery

Preferred Job Qualifications:

• HEDIS experience
• Project management experience
• Clinical quality innovation
• Knowledge of managed care programs (NCQA)

*This role is telecommute; must live within 250 miles of the posted location.

#LI - DP1

#LI-Remote

Referral Process: If referred, ask your HCSC connection about our Employee Referral process.

Pay Transparency

Our benefits include health and wellness, 401(k), pension, paid time off, parental leave, disability, life insurance, employee assistance, holidays, tuition reimbursement, and more. Learn more at https://careers.hcsc.com/totalrewards. Compensation varies based on skills, education, and experience, with potential for an annual incentive bonus.

Equal Opportunity Statement

We are committed to an inclusive environment. All qualified applicants will receive consideration regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics.

Base Pay Range

$60,300.00 - $133,400.00