Quality Risk & Grievance Lead, HEDIS & Audits

Universal Health Services; Riverside (CA); Vor Ort; USD 70.000 - 90.000; Vollzeit

Benefits dieser Stelle

Medical insurance

Dental insurance

Vision insurance

Life insurance

401(k) with company match

Discounted stock plan

Zusammenfassung

Universal Health Services operates Riverside Medical Clinic, a long-standing multispecialty facility serving the Riverside area since 1935. The Quality/GRIEVANCE role supports audits, HEDIS data collection, and QA initiatives to improve patient care and regulatory readiness.

Primary duties include preparing reports, coordinating audits, and addressing grievances and appeals in alignment with CMS and state regulations.

Qualifikationen

• Associates degree preferred.
• Two to three years of experience.
• Strong knowledge of patients rights and responsibilities; familiarity with EHR and incident tracking.
• CPHQ certification is a plus.

Aufgaben

• Prepare Health Plan required reports and coordinate annual audits.
• Prepare Corrective Action Plans from audits and access issues.
• Conduct mandatory annual medical record audits on all RMC practitioners.
• Coordinate annual HEDIS Data Collection Project.
• Conduct QA studies for clinic and surgery center areas; support AAAHC requirements.
• Perform periodic mini-surveys to maintain AAAHC readiness.
• Assist Manager, Quality and Regional Director with special projects.
• Coordinate CPPI (California Physician Performance Initiative).
• Review and respond to health plan grievances and appeals promptly.
• Assist with QRMC and MPC preparation.
• Other duties as assigned by management.

Kenntnisse

Patient rights

EHR familiarity

Grievances process

Quality initiatives

Incident tracking

Ausbildung

Associates degree

Tools

EHR software

Jobbeschreibung

Universal Health Services operates Riverside Medical Clinic, a long-standing multispecialty facility serving the Riverside area since 1935. The Quality/GRIEVANCE role supports audits, HEDIS data collection, and QA initiatives to improve patient care and regulatory readiness.

Primary duties include preparing reports, coordinating audits, and addressing grievances and appeals in alignment with CMS and state regulations.