Clinical Nurse Auditor, HEDIS Remote
About the position The on-call HEDIS Clinical Audit Coordinator is responsible for conducting clinical quality audits for the Quality Department. The auditor identifies and coordinates clinical audits to determine potential areas for quality improvement within the PHP network. The audit coordinator collects data by way of chart extraction, using objective specifications for the Healthcare Effectiveness and Data Information Set (HEDIS) program. Audits include review of outpatient medical records, hospital records, clinical lab and pharmacy records. The coordinator is responsible for collecting data based on standardized methodologies and organizes the data to identify and address opportunities for improvement. This position is an on-call position, and much of the work is seasonal. Individuals in this role will be able to perform chart audits electronically or on site in physician practices during the audit season, which runs approximately February through mid-May. The RN auditor will successfully complete HEDIS training prior to performing chart abstractions. Direction regarding charts require auditing will be provided by staff Clinical QI Coordinator RNs. The auditor maintains all collected records in a confidential manner and performs all duties in a manner which promotes team concept and reflects the Sisters of Providence mission and philosophy. The RN auditor will communicate in a collaborative manner with clinic and other staff with whom they interact, in a manner that represents Sisters of Providence. Providence caregivers are not simply valued - they're invaluable. Join our team at Providence Health Plan Partners 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. Accepting a new position at another facility that is part of the Providence family of organizations may change your current benefits. Changes in benefits, including paid time-off, happen for various reasons. These reasons can include changes of Legal Employer, FTE, Union, location, time-off plan policies, availability of health and welfare benefit plan offerings, and other various reasons. At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable. Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise. Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement. Responsibilities • conducting clinical quality audits for the Quality Department • identifies and coordinates clinical audits to determine potential areas for quality improvement within the PHP network • collects data by way of chart extraction, using objective specifications for the Healthcare Effectiveness and Data Information Set (HEDIS) program • Audits include review of outpatient medical records, hospital records, clinical lab and pharmacy records • collecting data based on standardized methodologies and organizes the data to identify and address opportunities for improvement • maintains all collected records in a confidential manner and performs all duties in a manner which promotes team concept and reflects the Sisters of Providence mission and philosophy • communicate in a collaborative manner with clinic and other staff with whom they interact, in a manner that represents Sisters of Providence Requirements • Degree in Nursing • Oregon Registered Nurse License • 5+ years clinical experience (Nursing) Nice-to-haves • 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. Benefits • best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security • retirement 401(k) Savings Plan with employer matching • health care benefits (medical, dental, vision) • life insurance • disability insurance • time off benefits (paid parental leave, vacations, holidays, health issues) • voluntary benefits • well-being resources Apply tot his job