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Clinical Quality Reviewer Jobs in Indiana (NOW HIRING)

Franciscan Health

Clinical Quality Specialist

Lafayette, IN · On-site

$35 - $47/hr

Performance, review and analysis of electronic clinical quality measures. * Provide education, and report to providers, frontline staff and other personnel, as appropriate for continuous quality ...

HHC

QUALITY REVIEW NURSE SPECIALIST

Indianapolis, IN · On-site

Performs on site and office review of various clinical resident care services and nursing ... Performs quality review oversight visits to HHC owned nursing homes and retirement communities as ...

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Clinical Quality Reviewer information

What does a clinical quality reviewer do?

A Clinical Quality Reviewer is responsible for evaluating clinical documentation, processes, and patient care activities to ensure they meet established quality standards and regulatory requirements. They review medical records, analyze compliance with protocols, and identify areas for improvement to enhance patient safety and care outcomes. Clinical Quality Reviewers often collaborate with healthcare teams to implement quality improvement initiatives and provide feedback or training as needed. Their work is essential for maintaining accreditation and ensuring continuous improvement in healthcare facilities.

What are the key skills and qualifications needed to thrive as a clinical quality reviewer, and why are they important?

To thrive as a Clinical Quality Reviewer, you need a solid background in healthcare, clinical knowledge, and quality assurance, often supported by a nursing or allied health degree and relevant certifications. Familiarity with clinical documentation systems, quality measurement tools, and regulatory compliance standards is typically required. Attention to detail, analytical thinking, and effective communication are vital soft skills for this role. These skills ensure accurate reviews, uphold compliance, and drive improvements in patient care quality.

What are some common challenges faced by clinical quality reviewers and how can they be addressed?

Clinical Quality Reviewers often encounter challenges such as interpreting complex clinical documentation, staying updated with regulatory changes, and ensuring consistent application of quality standards across diverse cases. To address these, it's important to maintain strong communication with clinical staff, participate in ongoing training, and utilize up-to-date review tools and checklists. Collaborating closely with other reviewers and quality teams can also help in sharing best practices and resolving ambiguous cases efficiently.

What are popular job titles related to Clinical Quality Reviewer jobs in Indiana?

For Clinical Quality Reviewer jobs in Indiana, the most frequently searched job titles are:

What job categories do people searching Clinical Quality Reviewer jobs in Indiana look for?

The top searched job categories for Clinical Quality Reviewer jobs in Indiana are:

Clinical Quality Reviewer jobs near you
Infographic showing various Clinical Quality Reviewer job openings in Indiana as of August 2026, with employment types broken down into 100% Full Time. Highlights an 50% In-person, and 50% Remote job distribution.

Clinical Quality Specialist

Indianapolis, IN • On-site

SIHO Insurance Services
Insurance Services • 51 - 200 employees
Learn more about SIHO Insurance Servicesexternal

$35 - $46.50/hr

Full-time

Re-posted 8 days ago

Job description

Job Title: Clinical Quality Specialist

Reports to: Director, Medical Management

The Clinical Quality Specialist supports the Clinical Quality Nurse in overseeing the HEDIS quality collection, submission, reporting, and auditing as well as assists with education to support the MyTruAdvantage line of business.

 

Key Responsibilities:

 

  • Knowledge of current HEDIS guidance, hybrid measure reporting, and measure compliance requirements.
  • Collaborate with Clinical Quality Nurse and internal data analyst to oversee HEDIS quality gap distribution to health partners and member providers for HEDIS clinical data collection.
  • Participate in communication with health partners regarding process of clinical document submission, annual education on applicable HEDIS measures, and cadence of reporting.
  • Help identify opportunities for improved or expanded HEDIS data collection.
  • Participate in internal chart chasing efforts.
  • Assure proper internal secure storage of HEDIS data collected from external providers.
  • Participate in Medical Record Review clinical submissions processes, assuring accuracy and completeness.
  • Support outreach efforts to external providers to collect clinicals needed for reporting.
  • Assist with maintaining all HEDIS related guidelines, policy & procedures, and auditing documents necessary for successful annual HEDIS audits.
  • Active participant in any external HEDIS audits performed as needed.
  • Support internal Chronic Care Improvement Program initiatives as needed.
  • Participate in internal or external process improvement efforts that support the quality improvement and collection efforts necessary for the Medicare Advantage or commercial lines of business. (Accurate provider attributions, training of health partners, training of new internal staff etc.)

Minimum Skills Requirement:

  • CMA or experience in clinical documentation review preferred.
  • Experience in working for or with HEDIS data collection and reporting preferred.
  • Proficiency in Microsoft Office Suite (Outlook, Word, Excel, PowerPoint).
  • Experience with electronic medical records and using online tools.
  • Ability to communicate professionally with physicians and office staff to facilitate organizational initiatives.
  • Willingness to obtain applicable HEDIS certifications deemed appropriate for position.

We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.