HEDIS Quality Improvement RN — Remote

Community Health Plan of Washington; Seattle (WA); Remote; USD 81,000 - 125,000; Full time

Job summary

Community Health Plan of Washington is seeking a HEDIS Quality Improvement Nurse to perform medical record review audits for NCQA and CMS audits. You will support developing provider audit reports, education, and opportunities for process improvement, while overreading and validating team output.

You must be a licensed RN or LPN with NCQA/HEDIS and CMS knowledge; a bachelor’s degree in nursing is preferred. Strong communication and analytical skills are essential in a regulatory-focused role.

Qualifications

• Licensed RN or LPN with NCQA/HEDIS and CMS Star documentation experience.
• Bachelor’s degree in nursing preferred or equivalent experience.
• Experience with NCQA guidelines, Medicare Part C & D Star notes.
• Strong communication and analytical skills; ability to report findings.
• Familiarity with Word, Excel, Outlook, Adobe Acrobat; SharePoint/Confluence helpful.

Responsibilities

• Perform medical record review audits for NCQA and CMS audits.
• Develop provider audit reports and provider education materials.
• Identify opportunities for process improvement and documentation coding education.
• Overread and validate colleagues’ documentation performance.
• Maintain regulatory knowledge of NCQA/HEDIS and CMS requirements.

Skills

NCQA HEDIS

HEDIS & CMS Star audits

Data analysis

Verbal & written communication

Pivot tables

NLP knowledge

Education

Bachelor’s degree in nursing

Tools

Microsoft Office

Adobe Acrobat

SharePoint

Confluence

Smartsheet

Pivot tables

Job description

Community Health Plan of Washington is seeking a HEDIS Quality Improvement Nurse to perform medical record review audits for NCQA and CMS audits. You will support developing provider audit reports, education, and opportunities for process improvement, while overreading and validating team output.

You must be a licensed RN or LPN with NCQA/HEDIS and CMS knowledge; a bachelor’s degree in nursing is preferred. Strong communication and analytical skills are essential in a regulatory-focused role.