HEDIS Improvement Nurse Short-term

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.

• 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

• 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

Telecommute (All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership)