Clinical Quality Reviewer - Nurse, Senior

Your Role

The Clinical Quality team is responsible for reviewing and abstracting medical records to capture data and to ensure accuracy and completeness. The Clinical Quality Reviewer - Nurse Senior will report to the Manager, Clinical Quality Analytics. In this role you will be reviewing medical records to support HEDIS and other regulatory audits. This role will require the ability to train others on HEDIS specifications and guidelines. This role will research and create medical record review reports and interpret findings.

Your Knowledge and Experience

• Bachelor of Science in Nursing or advanced degree preferred

• Current California RN license is required.

• Requires at least 5 years of prior relevant experience.

• Required 3 years of previous HEDIS Medical record review experience

• Excellent analytical and problem-solving skills.

• Requires deep knowledge of job area typically obtained through advanced education combined with experience.

• Viewed as a specialist within discipline. May have broad knowledge of project management.

• Required experience in Excel and HEDIS audits
• Desired experience and knowledge of medical record systems and processes
• Desired knowledge and familiarity in EMR software such as Epic, EClinical Works, Allscripts, NextGen, etc.
• Desired knowledge of ICD-10, CPT, and other modifier codes