HEDIS Quality Assurance Nurse- Remote

At GuideWell, we are committed to making diversity, equity and inclusion part of everything we do. We believe in hiring people who represent the communities we serve while creating a workplace that encourages a sense of belonging for everyone, no matter who you are or where you come from. From students to former military to seasoned professionals, our family of mission-based companies are stronger because of the unique talents and skills of our employees. We believe everyone’s contribution has the power to help people and communities achieve better health. Find your new team today.

Job Identification: 40609 Job Category: Medical Posting Date: 02/14/2025, 11:40 PM Job Schedule: Full time Job Shift: Day Organization: FLORIDA BLUE, GuideWell Locations: United States (Remote)

Participate in the activities of the Quality Improvement HEDIS QRS program to develop and implement initiatives and projects as assigned. Work collaboratively with internal and external data management and clinical resources to optimize data available for HEDIS and QRS. Work collaboratively to define potential clinical quality improvement activities within the corporation and with external HEDIS vendors and provider groups. Perform clinical quality assessment analysis to include all available information that comes from internal and external data, publicly available data, industry standards and other available information. Perform medical record reviews when necessary to support improvement and compliance, abstract HEDIS data, to include over-read of reviews. Assist with the review, analysis, and reporting of HEDIS/QRS results and identify opportunities for improvement.