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Under the direction of the Supervisor, Clinical Quality Improvement, the HEDIS Improvement Nurse provides support to the Supervisor, Clinical Quality Improvement and departments on HEDIS improvement related issues, serving as a resource for internal and external customers. Is able to interpret clinical data for QI-related studies for medical management. This position maintains a working knowledge of the current medical management system (MedHOK), business processes and workflows. Maintains summarized information for Quality Systems related to modified and new regulatory requirements for medical management from DHCS, DMHC and CMS.

Commitment to Quality: The Team is committed to incorporate the Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Education & Experience

• Associates degree required


• Three (3) or more years of any individual or combined experience in quality assurance, utilization management, case management, and/or health care informatics is required


• Experience preferably in an HMO or managed care setting

Key Qualifications

• Working knowledge of NCQA HEDIS technical specifications, medical terminology, and health plan processes preferred