JSG is seeking two Quality Improvement HEDIS Nurse Overreader's to support our client on a contractual basis in South San Francisco. This role involves assessing the effectiveness of care environments in meeting regulatory standards and ensuring evidence-based care. The QI Nurse will engage in a variety of tasks, including data collection, medical record review, regulatory compliance checks, and quality improvement activities, with the primary goal of optimizing member care outcomes.
Contract I Hybrid
Duties:
- Conduct Facility Site Reviews (FSRs), Physical Accessibility Reviews (PARs), and Medical Record Reviews (MRRs) using state-approved tools.
- Assess compliance with regulatory requirements through clinical knowledge and judgment.
- Document, report, and communicate findings as required; issue and monitor Corrective Action Plans (CAPs).
- Conduct pre-contractual compliance reviews with potential providers.
- Maintain comprehensive knowledge of Department of Health Care Services (DHCS) site review standards.
- Ensure accurate data collection, abstraction, and overreading of HEDIS records.
- Maintain compliance with National Committee for Quality Assurance (NCQA) standards.
- Manage and analyze quality-related data effectively.
- Track, trend, and report on outcomes for continued improvement.
- Develop and implement quality improvement plans.
- Respond promptly and professionally to internal and external inquiries.
- Ensure clear and timely communication with internal audiences, external stakeholders, and regulatory bodies.
- Keep accurate records of all assessments and reviews.
Qualifications:
- Current nursing license and experience in quality improvement and HEDIS processes.
- Strong clinical knowledge and judgment.
- Excellent organizational and communication skills.
- Proficient in data management and analyzing clinical outcomes.
- Familiarity with regulatory and NCQA standards
** Johnson Service Group (JSG) is an Equal Opportunity Employer. JSG provides equal employment opportunities to all applicants and employees without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, marital status, protected veteran status, or any other characteristic protected by law.
...creating exceptional customer experiences. Leverage Modern Support Stack: Architect a modern customer experience using tools like Zendesk, Gorgias, or Freshdesk across an e-commerce platform like Shopify. Command High Volume Inquiries: Confidently manage a high...
...Pikes Peak Oral Surgery | Colorado Springs, CO Dental Assistant Oral Surgery Surgical Assistant Oral Surgery This position is based in the office. It is not hybrid or remote. Position Highlights: Step into the fast-paced world of oral surgery as an Oral...
**Facility Security Officer, Government Security**The Dell Security & Resiliency organization manages the security risk across all aspects... ...writing security volumes for proposals, DD254s, and other contract mechanisms.**Take the first step towards your dream career**...
...KEY POSITION RESPONSIBILITIES Interprets and uses prints and sketches to perform layout and welding techniques for structural steel fabrication. Perform general material handling functions, such as; jobsite clean-up and moving of materials by hand. Operating motorized...
...platform-specific audiences (e.g., Amazon, Instagram, Walmart) Collaborate with marketing and creative teams to generate ideas and campaign messaging Research target audiences and products to craft compelling selling points Content Performance & Optimization...