Clinical Quality Reviewer - Nurse, Senior (HEDIS reviewer)

Your Role

The Clinical Quality Team is responsible for reviewing and abstracting medical records to capture data and to ensure accuracy and completeness. The Clinical Quality Reviewer - Nurse, Senior will report to the Manager, Clinical Quality Analytics. In this role you will be reviewing medical records to support HEDIS and other regulatory audits. This role will require the ability to train others on HEDIS specifications and guidelines. This role will research and create medical record review reports and interpret findings.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Knowledge and Experience

• Requires current CA RN license
• Bachelor of Science in nursing or advanced degree preferred
• Requires a minimum of 5 years of prior relevant experience
• Experience in HEDIS medical record review required
• Requires experience in Excel and HEDIS audits
• Desired experience and knowledge of medical record systems and processes
• Desired knowledge and familiarity in EMR software such as Epic, EClinical Works, Allscripts, NextGen, etc.
• Desired knowledge of ICD-10, CPT, and other modifier codes

Hybrid Virtual Work

This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.