HEDIS Improvement Nurse

IEHP

. Provide support to the Supervisor, Clinical Quality Improvement, and IEHP departments on HEDIS improvement-related issues .

Posted 11/9/2026full-timeRemote • California • United StatesMid-LevelSenior💰 $91,250 - $120,910 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Quality Improvement processes, particularly in HEDIS, CAHPS, and NCQA Accreditation, while effectively interpreting clinical data and maintaining compliance with regulatory requirements. Proficient in utilizing medical management systems and data analysis tools to support healthcare quality initiatives.

Highest-signal resume keywords

Registered Nurse (RN) LicenseHEDIS Technical SpecificationsQuality Assurance ExperienceData Analysis SkillsMicrosoft Office Suite Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Quality AssuranceUtilization ManagementCase ManagementHealth Care InformaticsData AnalysisMedical TerminologyHEDIS ImprovementRegulatory ComplianceMicrosoft AccessMicrosoft Office Suite

Soft Skills

Interpersonal SkillsCommunication SkillsProblem-Solving CapabilityAttention to DetailProject Management

Certifications & Qualifications

Associate's Degree in NursingBachelor's Degree in NursingRegistered Nurse (RN) License

Industry Keywords

HMOManaged CareNCQA AccreditationQuality ImprovementClinical Data Interpretation

About the role

Key responsibilities & impact

Provide support to the Supervisor, Clinical Quality Improvement, and IEHP departments on HEDIS improvement-related issues
Serve as a resource for internal and external customers
Interpret clinical data for QI-related studies for medical management
Maintain working knowledge of current medical management systems, business processes, and workflows
Maintain summarized information for Quality Systems related to modified and new regulatory requirements from DHCS, DMHC, and CMS
Support IEHP Quality Program goals, including HEDIS, CAHPS, and NCQA Accreditation

Requirements

What you’ll need

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
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
Basic knowledge of Microsoft Access
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 and data input
Strong problem-solving capability
Strong attention to detail

Benefits

Comp & perks

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