HEDIS RN – Quality Auditor

Duration: + months contract with potential extends or Convert

Job Description:

• The HEDIS Nurse Auditor is responsible for conducting quality audits related to state audits, HEDIS measures, and quality-related complaints and referrals.
• This role also supports data analysis and report preparation across various timeframes.

Responsibilities:

• Conduct on-site reviews at provider offices to assess record quality and compliance with documentation standards.
• Prepare reports summarizing findings and provide education and feedback to providers.
• Support data services to identify trends and facilitate quality improvement initiatives.
• Assist with clinical studies, quality projects, and audits.
• Lead and coordinate Corrective Action Plans (CAPs) and follow-up reaudits.
• Represent the organization for state audits and maintain documentation for compliance reporting.

Experience:

• – years of related experience, preferably in the healthcare industry.
• Active New Jersey Registered Nurse (RN) License required.

Skills:

• Knowledge of managed care principles and medical terminology.
• Familiarity with HEDIS guidelines and URAC accreditation standards preferred.
• Proficient in using personal computers and standard software applications.
• Understanding of health management and patient education practices is a plus.

Education:

• Bachelor of Science degree

About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit .

US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.