HEDIS Quality Improvement Nurse
Employment type
Full-time
Work setting
On-site
Location
Seattle, WA
Schedule
Day shift
Posted
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Job overview
The HEDIS Quality Improvement Nurse is an onsite role in Seattle, WA. Compensation is not specified. Community Health Plan of Washington is committed to reducing health disparities and applying an equity lens to its work. The nurse reviews and analyzes medical records for HEDIS, NCQA, and CMS audits, helping maintain accurate coding and documentation standards. The role supports provider feedback and education, quality assurance, audit validation, and process improvements across internal teams and external partners.
What you'll do
- Maintain and update HEDIS medical record review and coding guidelines
- interpret NCQA and Medicare Star technical changes
- present audit findings to internal teams, providers, and vendors
- prepare provider feedback reports and recommendations
- serve as a medical record review and coding subject matter expert
- overread and validate colleagues’ work
- complete annual HEDIS quality assurance and audit workflows
- identify process improvements
- support chart audits
- coordinate regulatory data validation
- perform root cause analysis and coding quality reviews.
What we're looking for
- Skills & competencies
- hedis quality improvement nurseregistered nurselicensed practical nursemedical record reviewcoding reviewncqacms medicare starsquality assuranceprovider feedbackseattle wacommunity health plan of washington
- Work arrangement
- Weekend coverage required
Benefits & perks
- Medical, prescription, dental, and vision coverage
- telehealth app
- flexible spending and health savings accounts
- life and disability insurance
- 401(k) with employer match
- employee assistance and financial coaching
- PTO, holidays, and community service time.
Why this role
Requires an active RN or LPN license and at least five years of combined NCQA, HEDIS, CMS Medicare Star medical-record and coding review experience.
About the employer
Community Health Plan of Washington is hiring for this role. Industry: Direct Health and Medical Insurance Carriers. Sector: 52.
Additional details
- Industry sector
- 52
- Industry
- Direct Health and Medical Insurance Carriers
- Occupation code
- 29-1141.00
You'll be redirected to the employer's application page.
Listing ID: 4f275a5c-f70a-44dd-8615-f94c5cfacbf7