HEDIS/Quality Improvement Nurse (LVN/RN)

Austin TX



  • Year-round chart abstraction/Medical Record review, including record requests, documentation and storage
  • Assist with completion of HEDIS roadmap items and audit preparation
  • Act as a HEDIS/STARS SME for internal and external stakeholders
  • Day to day management of CCIP’s
  • Assist clinical staff in mapping processes to support administrative extraction of HEDIS data as needed
  • Assist in designing clinical intervention plans to better support measures HEDIS/STARs measures
  • Conduct quality monitoring and review functions as assigned
  • Assist with HEDIS, STARS, CAHPs Stakeholder education and development of supporting materials
  • Able to conduct quantitative and qualitative analysis of data to identify needed areas of improvement
  • Collaborate with staff to facilitate improvement initiatives
  • Proficient understanding and application of Continuous Quality Improvement (CQI) principles
  • Facilitate completion of key Quality initiatives including health screening programs and disease management measurement
  • Support completion of core Quality documents (evaluation, program description, P&Ps, work instructions)
  • Maintain and enhance relationships between the business and the provider community/vendors to support quality outcomes
  • Maintain NCQA IDSS tool proficiency
  • Collaborate with Risk Adjustment to limit provider abrasion regarding record requests and ensure information sharing
  • Identifies problems or needed changes, recommends resolution, and participates in quality improvement efforts as per PDSA/PDCA methodologies
  • Provides consistent and accurate documentation and information
  • Plans, organizes and prioritizes assignments to comply with performance standards, corporate goals, and established timelines
  • Collaborate with stakeholders to ensure members move through the continuum of care according to best practices with the goals of facilitating quality health care
  • Other duties as assigned







  • Degree in nursing from an accredited university
  • Licensed LVN or RN
  • CPHQ, and or Six Sigma Green Belt preferred
  • 1 – 8 years’ related experience in managed care, public health or related field
  • Previous experience in Medicare Advantage and Medicaid programs is a plus
  • Experience with ESRD and/or dialysis is a plus
  • Ability to navigate various types of documentation software
  • Knowledge and understanding of accreditation planning and assessment methodologies and tools
  • Skill in examining and re-engineering operations and procedures, formulating policy, and developing and implementing new strategies and procedures
  • Skill in organizing resources and establishing procedures
  • Ability to educate staff regarding quality improvement requirements and deliverables
  • Effective time management
  • Capable of priority setting





Note: Qualified candidates will be contacted within 2 business days of application. If an applicant does not meet the above criteria, we will keep your resume on file for future opportunities and may contact you for further discussion.



Date Posted 8/2/2018
Salary Open

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