Hybrid-Remote Quality Improvement Nurse

Medical Mutual; Cleveland (OH); Hybrid; USD 80,000 - 110,000; Full time

Benefits offered by this job

On-site cafeteria

Gym membership reimbursement

Discounts

Cash rewards

Business casual attire

Job summary

Medical Mutual, based in Ohio, is seeking a Clinical Quality Improvement Nurse for a hybrid-remote position out of the Brooklyn, OH office. The role focuses on applying NCQA and CMS standards, performing chart reviews for HEDIS, and driving quality improvement initiatives across lines of business.

The ideal candidate is a licensed RN in Ohio with 3 years of clinical experience in a health plan, and may hold a BSN or higher. Strong data skills and collaboration with provider groups are essential.

Qualifications

• Graduate of a registered nursing program approved by the Ohio Board of Nursing.
• Bachelor of Science in Nursing preferred; Master’s Degree a plus.
• 3 years clinical RN experience, preferably in a health plan.

Responsibilities

• Collaborates with quality improvement team to support studies, education materials, provider engagement, vendor management and quality initiatives.
• Applies clinical expertise to collect HEDIS/study data through chart review and abstraction.
• Prepares narratives, reports, graphs, and procedures to support quality improvement and accreditation activities.
• Applies process and performance improvement methods to gain insight and measure effectiveness.
• Integrates findings into redesign of processes or clinical practices with cross-functional collaboration.
• Performs other duties as assigned.

Skills

Clinical expertise

Data analysis

Project management

Research & reporting

Quality improvement

Education

RN with Ohio license

BSN preferred

MSN a plus

Tools

PDSA/ DMAIC knowledge

NCQA/HEDIS knowledge

CMS regulations knowledge

Microsoft Office

Job description

Medical Mutual, based in Ohio, is seeking a Clinical Quality Improvement Nurse for a hybrid-remote position out of the Brooklyn, OH office. The role focuses on applying NCQA and CMS standards, performing chart reviews for HEDIS, and driving quality improvement initiatives across lines of business.

The ideal candidate is a licensed RN in Ohio with 3 years of clinical experience in a health plan, and may hold a BSN or higher. Strong data skills and collaboration with provider groups are essential.