Hedis Clinical Quality Jobs in Riverside, CA (NOW HIRING)

What you can expect!

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

Reporting to Director of Hospital Relations, the Quality Improvement, RN will facilitate quality improvement initiatives across the continuum of care (i.e. acute care hospitals, skilled nursing facilities, hospice agencies, etc.) to enhance the overall quality of care delivered to members. This position is responsible for identifying, developing, coordinating, promoting, supporting, and implementing assigned clinical quality, and/or service improvement projects and programs. The Quality Improvement, RN supports evidence-based practice integration, provider training/education, policy review/development, and regulatory/accreditation interpretation. The incumbent develops continuous and targeted activities to improve performance related to Centers for Medicare & Medicaid Services (CMS) Star Ratings, HEDIS, CAHPS, HOS, P4P and other identified performance measures. The Quality Improvement, RN provides direct support for multiple initiatives aimed at improving the quality and effectiveness of health care delivery and/or health care services. This position communicates with external partners, internal quality leaders, and stakeholders to ensure multi-disciplinary teams have the resources and information they need.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

• Competitive salary
• State of the art fitness center on-site
• Medical Insurance with Dental and Vision
• Life, short-term, and long-term disability options
• Career advancement opportunities and professional development
• Wellness programs that promote a healthy work-life balance
• Flexible Spending Account – Health Care/Childcare
• CalPERS retirement
• 457(b) option with a contribution match
• Paid life insurance for employees
• Pet care insurance

Education & Requirements

• Minimum four (4) years of clinical/health care experience required, including at least two (2) years performing quality improvement analysis or project coordination functions
• Bachelor’s degree in science or health/healthcare related field from an accredited institution required
• Master’s degree in science or health/healthcare related field from an accredited institution preferred
• Certified Professional of Healthcare Quality (CPHQ), or other recognized quality improvement certificate required or obtained within one (1) year of hire (maintained through employment)
• Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required

Key Qualifications

• Working knowledge of healthcare quality performance and measurement sets including CMS quality withhold, Managed Care Accountability Set, NCQA Quality Improvement Standards and HEDIS
• Ability to apply knowledge of tools of continuous improvement, and work process redesign
• Knowledge of advanced clinical processes and/or hospital operations
• Requires knowledge of the local healthcare market, patient demographics and needs and plan-specific information
• Good analytical and critical thinking skills
• Proficient in all Microsoft Office applications, with an emphasis on Excel and PowerPoint
• Effective communication skills (verbal, written and listening) with ability to interact with key stakeholders
• Must exhibit attention to detail
• Ability to successfully apply facilitation techniques to quality improvement project teams
• Demonstrates problem solving, conflict management, and team collaboration to contribute to a productive work environment and achievement of goals
• Ability to read and interpret data
• Able to manage and prioritize assigned tasks and work efficiently under pressure to meet deadlines in a fast-paced environment
• Ability to support the application of basic facilitation techniques within quality improvement project groups