Clinical Nurse Auditor, HEDIS *Remote*

About the position

The Clinical Nurse Auditor, HEDIS position at Providence Health Plan is a temporary, part-time role focused on conducting clinical quality audits to enhance healthcare quality within the organization. The auditor will be responsible for data collection, chart audits, and identifying areas for quality improvement, all while maintaining confidentiality and promoting teamwork. This role is essential during the HEDIS season, requiring full commitment from January to May 2025.

Responsibilities
• Conduct 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 through chart extraction for the HEDIS program.
,
• Review outpatient medical records, hospital records, clinical lab, and pharmacy records during audits.
,
• Organize data to identify and address opportunities for improvement.
,
• Perform chart audits electronically or on-site in physician practices during the audit season.
,
• Maintain all collected records in a confidential manner.
,
• Communicate collaboratively with the team to represent Providence Health Plan.

Requirements
• Degree in Nursing.
,
• Oregon Registered Nurse License.
,
• 5+ years clinical experience in Nursing.

Nice-to-haves
• 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.

Benefits
• 401(k) Savings Plan with employer matching.
,
• Health care benefits (medical, dental, vision).
,
• Life insurance.
,
• Disability insurance.
,
• Paid parental leave.
,
• Vacation and holiday time off.
,
• Voluntary benefits.
,
• Well-being resources.