Texas Health Resources HEDIS - Quality Auditor Specialist I - RN - Registered Nurse - SWHR CIN – Arlington in Dallas, Texas
Southwestern Health Resources is seeking to hire a HEDIS Quality Auditor RN – Registered Nurse; to support our HIMS Quality Audits Reporting Department.
Office location: Windhaven building located at 6800 Windhaven Parkway, Suite 133, The Colony, TX 75056. This position is remote, must live in the Dallas/Fort Worth Texas area.
Salary range is $33.27/hour – Max 49.29/hour – based on relevant experience.
• Full-time: 40 hours per week, Days, 8am-5pm
The position is accountable for a comprehensive medical record review for quality measure audits and will provide providers with education and training in measure specification and documentation. The essential job duties for this position are:
• Complete HEDIS Quality Audits in a timely and accurate manner.
• Complete audits according to NCQA and CMS measure specifications.
• Communicate to Supervisor/Manager audit barriers, obstacles or concerns.
• Meet required audits per day target.
Participate in quality improvement initiatives, such as, but not limited to Quality Mobile Health Services, documentation in the electronic health record and/or provide clinical expertise to develop clinical recommendations for quality metrics, clinical workflows, research and education.
• Utilize audit findings to facilitate and provide education.
• Communicate quality measures that have consistently not been meet. Identify and provide feedback on measures that need to be ordered/obtained via the appropriate process.
• Will identify areas of targeted quality measures adherence that need improvement and organize as needed training sessions.
with assigned providers and/or their administrative staff.
• Participate in development as subject matter expert in education, resource development and or training tools.
• Utilize clinical expertise for development and use of auditing tools/templates /resources and education.
• Other Duties as assigned
• Work with supervisor to develop and maintain workflow and process for conducting the audit by agreed upon deadline.
• Provide supervisor with data collection, metrics and/or reports, evaluation of curriculum and opportunities for improvement.
The ideal candidate will possess the following qualifications:
• Associates degree in Nursing from an accredited RN program (AND) required OR
• Bachelor's Degree in Nursing from an accredited RN program (BSN) required.
• 4 Years of experience in healthcare to include 2 years of experience in auditing (w/Bachelor's degree) required Or
• 6 Years of Experience in healthcare to include 2 years of experience in auditing (with Associates degree) required.
• Experience abstracting or auditing, or HEDIS Educator highly preferred.
• RN – Registered Nurse, Active Texas RN license upon hire required.
• Ability to read and interpret all types of medical records, including physician documentation.
• Independent problem identification/resolution, critical thinking and decision making skills.
• Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously.
• Possess planning, organizing, conflict resolution, negotiating, collaborative and interpersonal skills.
• Ability to work collaboratively in a team-oriented environment with a strong customer-service orientation.
• Strong written and verbal communication skills; strong analytical, organizational and time management skills required.
• Proficiency in Microsoft Office Word, Excel and Access.
Southwestern Health Resources Clinically Integrated Network (SWHR CIN) is an affiliated company of Texas Health and UT Southwestern. If hired for this position, you will become a SWHR CIN employee rather than a Texas Health or UT Southwestern employee.
Employment opportunities are only reflective of wholly owned Texas Health Resources entities.
We are an Equal Opportunity Employer and do not discriminate against any employees or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.