HEDIS Nurse

Company Description Rangam is a global, innovative Total Talent management firm with over 25 years of experience. We are a minority-, woman-, and disability-owned company committed to promoting sustainable and inclusive talent programs. Our mission is to accelerate meaningful employment for everyone, and our vision is to be the world's leader in connecting talent, communities, and employers. We value empathy, integrity, agility, inclusion, and innovation in everything we do. (Candidates only from NY, NJ, PA, CT and DE will be consider) Role Description We're looking for a highly organized and experienced Quality Audit & Compliance Specialist to join our team. This role is crucial for ensuring our participating providers meet rigorous State Audit and HEDIS documentation standards. If you have a strong background in healthcare auditing, enjoy data analysis, and hold an active LPN or RN license in New Jersey, we want to hear from you! Key Responsibilities: Conduct On-Site Audits: Perform reviews at provider offices to assess the environment, the quality of medical records, and compliance with documentation standards. Audit Management & CAPs: Serve as the in-house project lead for State Audits. Coordinate and manage the Corrective Action Plan (CAP) process, and conduct reaudits to ensure deficiencies are addressed. Reporting & Analysis: Prepare detailed documentation summarizing on-site findings. Produce various weekly, monthly, quarterly, and year-end reports and analyze trends/patterns to drive quality improvement. Training & Education: Provide education to physicians on audit findings and opportunities for improvement. Assist in training both internal staff and external providers/vendors on audit standards and programs. Special Projects: Support the Quality Management department by assisting with various special projects, focused clinical studies, and quality referral/complaint issues. Required Qualifications: Experience: 3–5 years of related business experience, preferably within the healthcare industry. License: Active New Jersey Registered Nurse (RN) License or Licensed Practical Nurse (LPN) License. Knowledge: Strong understanding of managed care principles and medical terminology. Skills: Excellent communication (verbal/written), strong analytical skills, presentation skills, and high proficiency in PC software (MS Office). Mobility: Requires a valid Motor Vehicle Driver’s License and access to an automobile for travel to provider offices. Knowledge of URAC accreditation standards and HEDIS principles. Apply tot his job Apply To this Job