HEDIS & CMS Quality Improvement Nurse

Community Health Plan of Washington; Washington; On-site; USD 85,000 - 115,000; Full time

Benefits offered by this job

Medical, Prescription, Dental, Vision

Telehealth app

401(k) Retirement with employer match

Paid time off and holidays

Job summary

Community Health Plan of Washington seeks a qualified HEDIS Quality Improvement Nurse to perform medical record review audits for NCQA and CMS programs. You will support provider education, develop audit reports, and help identify opportunities for process improvement.

The role requires RN or LPN licensure and 5+ years in NCQA/HEDIS and CMS reviews, with strong MS Office and Adobe Acrobat skills. A Bachelor’s in nursing is preferred; NLP and Star experience are a plus.

Qualifications

• Licensed RN or LPN required.
• 5+ years combined NCQA/HEDIS and CMS Medicare Star medical record review experience.
• Experience with Microsoft Office Suite and Adobe Acrobat; pivot tables preferred.
• Bachelor’s degree in nursing or equivalent experience preferred.

Responsibilities

• Support updating CHPW HEDIS medical record review and coding guidelines per NCQA specs.
• Present findings to internal audiences and provider teams.
• Update provider feedback reports and identify trends with recommendations.

Skills

RN/LPN licensure

NCQA/HEDIS & CMS reviews

Strong communication

Education

Bachelor’s degree in nursing

Tools

Microsoft Office

Adobe Acrobat

SharePoint

Confluence

Smartsheet

Job description

Community Health Plan of Washington seeks a qualified HEDIS Quality Improvement Nurse to perform medical record review audits for NCQA and CMS programs. You will support provider education, develop audit reports, and help identify opportunities for process improvement.

The role requires RN or LPN licensure and 5+ years in NCQA/HEDIS and CMS reviews, with strong MS Office and Adobe Acrobat skills. A Bachelor’s in nursing is preferred; NLP and Star experience are a plus.