Remote RN - Quality Program & Site Review (HEDIS)

Inland-Empire-Health-Plan-; California (MO); Remote; USD 91,000 - 121,000; Full time

Benefits offered by this job

Competitive salary

On-site fitness center

Medical, dental, vision insurance

Disability insurance (short/long-term)

Career development opportunities

Wellness programs

FSA – Health Care/Childcare

CalPERS retirement

457(b) plan

Job summary

Inland Empire Health Plan (IEHP) seeks a Quality Program Nurse to implement and monitor quality management policies under the DHCS framework. Responsibilities include site reviews, medical record surveys, CAP oversight, and HEDIS data abstraction.

The role requires CA RN licensure, CSR certification or willingness to obtain it, and collaboration across QM teams. Remote work is allowed with periodic on-site meetings and potential Inland Empire travel.

Qualifications

• 3+ years in Quality Assurance, Utilization Management, Case Management, or clinical hospital experience.
• Experience in an HMO/Managed Care setting preferred.
• Willing and able to obtain CSR within 6 months of hire.

Responsibilities

• Perform Site Review and Medical Record Surveys for assigned PCPs and related regulatory audits.
• Review CAP submissions and monitor CAP compliance.
• Conduct focused audits as directed by IEHP Committees.
• Perform annual HEDIS data abstractions and track findings.
• Monitor PCPs for issues and document observations.
• Attend QM Committee and Subcommittee meetings as required.

Skills

Nursing knowledge

Written and verbal communication

Organizational skills

Time management

Critical thinking

Interpersonal skills

Driver's license

Education

Associate’s degree in Nursing

Bachelor’s degree in Nursing

CSR Certificate

RN license (CA)

Job description

Inland Empire Health Plan (IEHP) seeks a Quality Program Nurse to implement and monitor quality management policies under the DHCS framework. Responsibilities include site reviews, medical record surveys, CAP oversight, and HEDIS data abstraction.

The role requires CA RN licensure, CSR certification or willingness to obtain it, and collaboration across QM teams. Remote work is allowed with periodic on-site meetings and potential Inland Empire travel.