HEDIS Improvement Nurse Short-term
California
What you can expect!
Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!
Under the direction of the Supervisor, Clinical Quality Improvement, the HEDIS Improvement Nurse provides support to the Supervisor, Clinical Quality Improvement and IEHP departments on HEDIS improvement related issues, serving as a resource for internal and external customers. This role interprets clinical data for QI-related studies for medical management. This position maintains a working knowledge of the current medical management systems, business processes and workflows. The HEDIS Improvement Nurse maintains summarized information for Quality Systems related to modified and new regulatory requirements for medical management from DHCS, DMHC and CMS.
Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.
Perks
IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.
- Competitive salary
- State of the art fitness center on-site
- Medical Insurance with Dental and Vision
- Life, short-term, and long-term disability options
- Career advancement opportunities and professional development
- Wellness programs that promote a healthy work-life balance
- Flexible Spending Account – Health Care/Childcare
- CalPERS retirement
- 457(b) option with a contribution match
- Paid life insurance for employees
- Pet care insurance
Education & Experience
- Three (3) or more years of any individual or combined experience in quality assurance, utilization management, case management, and/or health care informatics
- Experience in an HMO or managed care setting preferred
- Associate's degree in Nursing from an accredited institution required
- Bachelor's degree in Nursing from an accredited institution preferred
- Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required
Key Qualifications
- Advanced knowledge of NCQA HEDIS technical specifications, medical terminology, and health plan processes preferred
- Advanced knowledge of the current medical management systems and how information is stored and retrieved
- In-depth understanding of current HEDIS technical specifications with the ability to interpret changes and clarifications accurately
- Possess basic knowledge of Microsoft Access to look up Member data for purposes of verifying clinical services needed or received
- Data analysis and Computer applications, including word processing, databases, and spreadsheets
- Proficient in Microsoft Office Suite. Excellent interpersonal/communication skills
- Ability to handle multiple projects, data input, strong problem-solving capability
- Strong attention to detail
Start your journey towards a thriving future with IEHP and apply TODAY!
Pay Range
- $91,249.60 USD Annually - $120,910.40 USD Annually
Working at IEHP is always about helping our members and helping our team members and for me to address anything that they need from me. It’s something that I take pride in every day.
Maynard Mungcal Learning & Development Analyst 2
I love working for IEHP. I really think they not only care about their members, but they also care about their employees … I've been here for eight years, and I just love it!
Mayra Gomez Senior Pharmacy Medication Management Specialist
It’s not just clocking in and clocking out, but being thoughtful and being proud and being an advocate for the work that we do … When people ask me how my day was or how my work is, it’s something that I’m profoundly proud of because I know that I’m making a difference.
Phillip Lo Director of Business Continuity
