Quality Risk & Grievance Lead — HEDIS & Audits

Riverside Medical Clinic; Riverside (CA); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Challenging and rewarding work环境

Competitive compensation and paid time

Excellent Medical, Dental, Vision and 

401(K) with company match and stock

Job summary

Riverside Medical Clinic is seeking a Quality Improvement/Compliance Coordinator to manage health plan reporting, audits, and HEDIS data collection across Riverside. This role leads the daily operations of grievances and appeals, ensuring timely investigations and regulatory alignment.

The position supports quality studies, CAP development, and QA initiatives, collaborating with leadership to improve patient care and compliance with CMS, CDPH, and DMHC guidelines.

Qualifications

• Associates degree preferred; two to three years experience in healthcare QA preferred.
• Strong knowledge of Patients rights and responsibilities; familiarity with electronic health record (EHR).
• Experience with incident tracking based on grievances and appeals trends; capable of coordinating case reviews.
• Ability to develop and monitor quality initiatives in a healthcare setting.

Responsibilities

• 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 relevant Q.I. studies for both the clinic and surgery center areas and/or any other AAAHC Regulatory preparation/requirements.
• Perform periodic random mini- surveys at all locations to maintain AAAHC “readiness”.
• Assist Manager, Quality, and/or Regional Director, Quality and/or Medical Director with special projects.
• Coordinate CPPI (California Physician Performance Initiative).
• Review/respond to health plan or individual grievances and appeals in a timely manner.
• Assist with QRMC and MPC preparation
• Any other responsibilities requested by Manager, Regional Director, and Medical Director .

Skills

Patient rights and responsibilities

Electronic Health Record (EHR)

Grievances & appeals tracking

Case review coordination

Quality initiative development

Education

Associates degree preferred

Two to Three years healthcare experience

Current California LVN License

CPHQ certification preferred

Job description

Riverside Medical Clinic is seeking a Quality Improvement/Compliance Coordinator to manage health plan reporting, audits, and HEDIS data collection across Riverside. This role leads the daily operations of grievances and appeals, ensuring timely investigations and regulatory alignment.

The position supports quality studies, CAP development, and QA initiatives, collaborating with leadership to improve patient care and compliance with CMS, CDPH, and DMHC guidelines.