Providence Health & Services RN - HEDIS Clinical Audit Coordinator in Beaverton, Oregon

Description:

Providence is calling a RN - HEDIS Clinical Audit Coordinator to Providence Health & Services in Beaverton, OR.

In this position you will have the following responsibilities:

  • Responsible for the completion of Quality monitoring and chart abstraction audits. Quality audits include but are not limited to: patient health information, clinical testing and follow-up, quality of provider services and medical management, medical record requirements, and other quality requirements as defined by PHP, performance measurement specifications, or Federal and State regulations.

  • Be able to investigate perceived gaps in care identified through claims in order to identify documentation necessary to support exclusions or numerator hits. Use claims information to track where member has received care.

  • Adhere to a tight schedule of pre-scheduled clinic visits combined with in-office reviews. Site visits could be at facilities in Oregon or Washington (as RN license supports).

  • Conduct clinical reviews using medical record/medical information. Use audit tools, conduct auditor training, perform tool validation, and conduct audits. Work with analytical staff to develop and maintain effective databases and reporting. Work with quality team to assure documentation is audit-ready.

  • Identify concerning care patterns by use of audits and audit reports.

  • Understand and communicate to practices basic specifications around HEDIS or other clinical measures being audited.

Qualifications:

Required qualifications for this position include:

  • Degree in nursing

  • OR RN License

  • 5 years clinical experience

  • 1 year of quality management/quality improvement/utilization review auditing experience, including experience in auditing within electronic health records.

  • Knowledge of current clinical practices specifically chronic diseases and guidelines for preventive health maintenance

  • Ability to travel to clinic sites to perform the chart abstractions, use of own vehicle

  • Comfort with functioning in various Electronic Health Record systems, including PHP’s claims system

  • Proficiency in Microsoft Office software applications required (Word, Excel, or other similar database).

Preferred qualifications for this position include:

  • BSN

  • Experience with health plans, project management, program evaluation, team facilitation, data analysis, and/or case review

About Providence in Oregon

As the largest healthcare system and largest private employer in Oregon, Providence offers exceptional work environments and unparalleled career opportunities.

The Providence Experience begins each time our patients or their families have an encounter with a Providence team member and continues throughout their visit or stay. Whether you provide direct or indirect patient care, we want our patients to feel that they are in a welcoming place where they can be comfortable and free from anxiety. Our employees create the Providence Experience through simple, caring behaviors such as acknowledging and welcoming each visitor, introducing ourselves and Providence, addressing people by name, providing the duration of estimated wait times and updating frequently if timelines change, explaining situations in a way that puts patients at ease, carefully listening to their concerns, and always thanking people for trusting Providence for their healthcare needs. At Providence, our quality vision is simple,

"Providence will provide the best care and service to every person, every time."

Providence is consistently ranked among the top 100 companies to work for in Oregon. It is also home to two of our award-winning Magnet medical centers. Providence hospitals and clinics are located in numerous areas, ranging from the Columbia Gorge to the wine country to sunny southern Oregon to charming coastal communities to the urban setting of Portland. If you want a vibrant lifestyle while working with a team highly committed to the art of healing, choose from our many options in Oregon.

We offer a full comprehensive range of benefits - see our website for details

http://www.providenceiscalling.jobs/rewards-benefits/

Our Mission

As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.

About Us

Providence Health & Services is a not-for-profit Catholic network of hospitals, care centers, health plans, physicians, clinics, home health care and services guided by a Mission of caring the Sisters of Providence began over 160 years ago. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

Schedule: Full-time

Shift: Day

Job Category: Health Plans

Location: Oregon-Beaverton

Req ID: 203552