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Working Each Day to Make a Difference

At Community Health Plan of Washington, we're driven by our belief that everyone deserves access to quality health care.

More than 25 years ago, we made a commitment to improve the health of our communities by making quality health care accessible to all Washington state residents.

We continue that pledge today by providing affordable comprehensive coverage to more than 315,000 individuals and families throughout the state.

• We are a local not-for-profit health plan in Washington State.
• We are committed to keeping Washington families healthy.
• We connect our communities to the health resources they need.
• We provide access to high-quality care for our members.
• We connect and empower our members through technology.
• The Community Health Centers we partner with strive to support members with a comprehensive mix of medical resources in one convenient location.
• Our partnerships with Community Health Centers and our extended provider network help us improve the health care delivery system.

To learn more about how you can make a difference working at Community Health Plan of Washington, visitwww.chpw.org{rel="nofollow"}.

HEDIS Quality Improvement Nurse

This position is available fully remote within Washington State

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[POSITION PURPOSE:]{.underline}

The HEDIS Quality Improvement Nurse is responsible for performing medical record review audits and analysis for regulatory National Committee for Quality Assurance (NCQA) and Centers for Medicare & Medicaid Services (CMS) audits. This role supports assisting the Manager with developing provider audit reports, provider education, identifying opportunities for process improvement, performs overread and peer review of other team member output.

[PRINCIPAL DUTIES:]{.underline}

Support updating and maintaining CHPW HEDIS medical record review and coding guidelines to reflect changes of the NCQA HEDIS Technical Specification and Medicare Part C & D Star Technical Notes. Interpret changes and support modifying CHPW policies in coordination with HEDIS Performance Measurement Manager and HEDIS Program Manager.

Keep current on regulatory, medical record documentation and coding issues/best practices including NCQA Guidelines for Medical Record Documentation, Coding and Reporting.

Present findings via verbal and written updates to internal audiences including peer to peer, department leadership reporting, provider and clinical teams, and vendor support teams.

Update and distribute provider feedback reports to HEDIS Performance Manager as needed for identifying provider performance trends and participate in creating materials for all significant audit findings including trends and associated recommendations (e.g., training, oversight, monitoring, process flow changes, documentation, and coding education) specific to internal departments, coding vendors, and others.

Serve as medical record review and coding SME. Support overread and validation of other colleagues' documentation performance.

Complete the annual regulatory HEDIS medical record review and coding quality assurance process and workflow of the primary source validation and retrospective medical record and coding audit.

Identify and implement practices and Quality Assurance process improvement.

Monitor and comply with internal medical record and coding guidelines, department policies, and NCQA/CMS quality program guidelines, rules, and regulations.

Continuous development of knowledge in Medicare, Medicaid, and Exchange programs to ensure timely review of regulatory medical record documentation an