Clinical Nurse Auditor, HEDIS *Remote
Position: Clinical Nurse Auditor, HEDIS *Remote* Be among the first 25 applicants. Get AI-powered advice on this job and more exclusive features. Overview Providence Health Plan caregivers are not simply valued – they’re invaluable. Join our team and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here because we know that to inspire and retain the best people we must empower them. Responsibilities • Conduct clinical quality audits for the Quality Department. • Identify and coordinate clinical audits to determine potential areas for quality improvement within the PHP network. • Collect data by chart extraction using objective specifications for the Healthcare Effectiveness and Data Information Set (HEDIS) program. • Conduct audits that include review of outpatient medical records, hospital records, clinical lab and pharmacy records. • Collect data based on standardized methodologies. • Organize data to identify and address opportunities for improvement. • Perform chart audits electronically or on site in physician practices during the audit season. • Successfully complete HEDIS training prior to performing chart abstractions. • Maintain all collected records in a confidential manner. • Perform all duties in a manner that promotes team concept and reflects the Providence Health Plan's mission and philosophy. • Communicate in a collaborative manner with the team in a way that represents Providence Health Plan. Qualifications • Degree in Nursing. • Oregon Registered Nurse License. • 5+ years clinical experience (Nursing). Preferred Qualifications • Bachelor's Degree in Nursing. • Dual RN License: Oregon and Washington. • 1 year Quality management/quality improvement/utilization review auditing experience, including experience in auditing within electronic health records. • Experience with health plans, project management, program evaluation, team facilitation, data analysis, and/or case review. Remote Work • Remote work is welcome for applicants who reside in Washington or Oregon. Benefits Providence offers a comprehensive benefits package including 401(k) with matching, health, dental, vision, life, disability, paid leave, and more. Equal Opportunity Providence is a proud Equal Opportunity Employer and is committed to a workforce free from discrimination and harassment. #J-18808-Ljbffr Apply tot his job Apply tot his job