Clinical Nurse Auditor, HEDIS *Remote* | Providence Jobs
About the Team
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.
Description
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.
Providence Health Plan is calling a Clinical Nurse Auditor, HEDIS who will:
- Be responsible for conducting 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 way of chart extraction, using objective specifications for the Healthcare Effectiveness and Data Information Set (HEDIS) program.
- Conduct audits, which include review of outpatient medical records, hospital records, clinical lab and pharmacy records.
- Be responsible for collecting 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 which 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.
Please note the following important detail regarding this HEDIS Seasonal Role:
- This posting is for multiple openings of a Nurse Auditor, HEDIS.
- This position is affiliated with Providence Health Plan and will be tied to a location and compensation range in Beaverton, Oregon.
- Length of Program Anticipated to last between: January 2025 - May 2025.
- Work Schedule: Monday - Friday.
- Work Hours Scheduled Weekly: 40.
- Additional Info:This position will require a full-time commitment to the project, meaning no extended time off during the HEDIS Season (January 2025 - May 2025).
Required qualifications for this position include:
- Degree in Nursing.
- Oregon Registered Nurse License.
- 5+ years clinical experience (Nursing).
Preferred qualifications for this position include:
- Bachelor's Degree in Nursing.
- Dual RN License: Oregon and Washington.
- 1+ years' experience in Quality Management, Quality Improvement, Utilization Review Auditing.
- 1+ years' experience auditing electronic health records.
- Experience with health plans, project management, program evaluation, team facilitation, data analysis and or case review.
- Experience working as a Nurse supporting a minimum of one HEDIS Audit season.
Why Join Providence Health Plan?
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.
About Providence
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.
Requisition ID: 313757
Company: Providence Jobs
Job Category: Nursing-Patient Facing
Job Function: Nursing
Job Schedule: Part time
Job Shift:
Career Track: Nursing
Department: 5018 HCS QUALITY MANAGEMENT OR REGION
Address: OR Beaverton 3601 SW Murray Blvd
Work Location: Murray Business Ctr Beaverton-Beaverton
Pay Range: $40.20 - $63.64
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
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