Top 72 Hedis nurse Jobs in Texas

Sr. Quality of Care Review Nurse
Oscar Health —Dallas, TX
- $83,628.00 - $109,761.75 a year
- Remote
- Spanish
- Nursing
- RN License
- Paid parental leave
- Paid holidays
Quick Apply
Quality Metrics Specialist-Health Plan
Cook Children's Health Care System —Texas
- Full-time
- Remote
- Microsoft Excel
- LVN
- RN License
Medical Assistant
Conviva Senior Primary Care —Corpus Christi, TX
- $43,000 - $56,200 a year
- Full-time
- Spanish
- CPR Certification
- Vital signs
- Paid parental leave
- Paid holidays
20h
Clinical Quality Improvement Coordinator - Eye Exam Specialist -
Guidehealth —Houston, TX
- $60,000 - $64,000 a year
- Full-time
- Hybrid work
- Microsoft Outlook
- Mid-level
- Driver's License
- Paid parental leave
- Disability insurance
2d
Behavioral Health Case Manager
MyCHN —Pearland, TX
- Full-time
- Mid-level
- Leadership
- Communication skills
Quick Apply
3d
Program Manager HEDIS Nurse - HP Medical Management
Christus Health —Irving, TX
- Full-time
- Nursing
- LVN
- RN License
1d
HEDIS Performance Improvement Specialist
Ascension —Austin, TX
- $75,295.00 - $110,834.59 a year
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Disability insurance
- Health insurance
Clinical Program and Quality Manager
Everly Health —Austin, TX
- Full-time
- Nursing
- RN License
- HIPAA
6d
Licensed Nurse Care Coordinator - Population Health
Christus Health —Irving, TX
- Full-time
- LVN
- Medical office experience
- Mid-level
10d
Clinical Program and Quality Manager
Everlywell —Austin, TX
- Full-time
- Hybrid work
- Nursing
- RN License
- HIPAA
6d
PRN Physician
Centerwell —DeSoto, TX
- $310,000 - $368,500 a year
- Part-time
- Medicine
- Outpatient experience
- Clinic
- 401(k)
- Paid time off
9d
Supervisor, Medical Referrals- Houston, TX
Centerwell —Houston, TX
- $65,200 - $89,000 a year
- Full-time
- Medical office experience
- Mid-level
- Driver's License
- Paid parental leave
- Paid holidays
9d
Director of Population Health & Care Management
WACO FAMILY MEDICINE —Waco, TX
- Full-time
- Nursing
- RN License
- 5 years
Care Manager - RN (Bilingual Spanish Preferred)
Astrana Health, Inc. —Houston, TX
- $80,000 - $94,000 a year
- Email
- Hybrid work
- Spanish
- Nursing
- RN License
Quick Apply
Bilingual Clinical Care Nurse (RN)
Conviva Senior Primary Care —San Antonio, TX
- $71,100 - $97,800 a year
- Full-time
- Spanish
- Nursing
- RN License
- Paid parental leave
- Paid holidays
Registered Nurse - Women's Health
Healing Hands Ministries Inc —Dallas, TX
- $40 - $45 an hour
- Extended hours
- Nursing
- RN License
- BLS Certification
- AD&D insurance
- Paid holidays
Quick Apply
Practice Performance Manager (Houston, TX)
Apex Health Solutions —Houston, TX
- Nursing
- Microsoft Excel
- LVN
Quick Apply
Clinical Care Nurse (RN)
Conviva Senior Primary Care —San Antonio, TX
- $71,100 - $97,800 a year
- Full-time
- Spanish
- Nursing
- RN License
- Paid parental leave
- Paid holidays
Coding Educator/Auditor
University Health —San Antonio, TX
- $25.10 - $40.25 an hour
- Full-time
- RN License
- 5 years
- Analysis skills
- Gym membership
- Opportunities for advancement
Coding Educator
University Health - San Antonio —San Antonio, TX
- $25.10 - $40.25 an hour
- Full-time
- RN License
- Hospital
- 5 years

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hedis nurse jobs near texas

Sr. Quality of Care Review Nurse

Oscar Health -
Dallas, TX

Quick Apply

Job Details

$83,628.00 - $109,761.75 a year

Benefits

Paid parental leave
Paid holidays
Disability insurance
Health insurance
Dental insurance
Parental leave
Vision insurance
Paid sick time

Qualifications

RN License
Patient care

Full Job Description

Hi, we're Oscar. We're hiring a Sr. Quality of Care Review Nurse to join our Quality team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role:

Clinical Quality programs are designed to enhance clinical outcomes and concierge-level service to our members, through review of services provided to members from network healthcare providers, facilities and Oscar employees. The Senior Quality of Care Nurse analyzes clinical data, tracks core measures, reviews patient records, and implements evidence-based strategies to improve overall provider and facility standard of care. As well as, optimizing clinical experience into clear detailed medical reviews while upholding department standards for quality and productivity. The Quality of Care Nurse Reviewer evaluates and refines healthcare processes to optimize patient safety, clinical outcomes, and regulatory compliance.

You will report into the Nurse Manager, Quality of Care.

Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote

Pay Transparency: The base pay for this role is: $83,628 - $109,761.75 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities:

Reviewing member complaints that need to be escalated immediately and resolved within 60 calendar days of receipt through review of services provided to members from network healthcare providers, facilities and Oscar employees.
Perform quality of care review to determine whether records or commentary from the provider/facility will be needed in order to accurately determine whether a quality issue did occur.
Conduct root cause analyses for adverse events, sentinel events, or potential quality issues to prevent future occurrences.
Investigate provider and facility quality of care concerns, identifying and escalating negative performance trends for corrective action when appropriate.
Perform annual medical record reviews for selected states.
Consult with internal stakeholders to ensure that quality of care needs or members are met while adhering to accreditation and regulatory requirements.
Present quality and performance trend data to organizational stakeholders, delegates and quality subcommittees as applicable; Collaborate on corrective action plans to address identified gaps.
Compliance with all applicable laws and regulations
Other duties as assigned

Requirements:

Licensed Registered Nurse with active, unrestricted license in state of residence and willingness to obtain additional licenses as needed for Oscar's growth (with Oscar's support)
2+ years of experience as a Registered Nurse
2+ years experience working in a clinical care setting

Bonus points:

Health plan utilization management experience or case management experience.
Experience in healthcare quality assurance, including experience auditing medical records and evaluating clinical information and internal documentation to determine the quality of care and service provided to members.
Experience in health plan case management.
Bilingual - fluent in Spanish to audit Spanish-language verbal and written interactions.
Bachelor's Degree from an accredited university, BSN Preferred.
A working knowledge of health insurance/benefit concepts - Medicare and Individual Marketplace insurance experience a plus.
Experience with NCQA accreditation standards for utilization management, case management or population health, HEDIS measures and other regulatory requirements.
CCM or MCG certification.
Experience analyzing performance and other forms of data.
Proficiency using Google applications like Sheets, Docs, Slides and Meets.
Comfortable using Google Meets and other platforms to communicate with internal/external partners.

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care - an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team ([email protected]) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

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Refine Your Search

hedis nurse jobs in texas

Sr. Quality of Care Review Nurse

Quality Metrics Specialist-Health Plan

Medical Assistant

Clinical Quality Improvement Coordinator - Eye Exam Specialist -

Behavioral Health Case Manager

Program Manager HEDIS Nurse - HP Medical Management

HEDIS Performance Improvement Specialist

Clinical Program and Quality Manager

Licensed Nurse Care Coordinator - Population Health

Clinical Program and Quality Manager

PRN Physician

Supervisor, Medical Referrals- Houston, TX

Director of Population Health & Care Management

Care Manager - RN (Bilingual Spanish Preferred)

Bilingual Clinical Care Nurse (RN)

Registered Nurse - Women's Health

Practice Performance Manager (Houston, TX)

Clinical Care Nurse (RN)

Coding Educator/Auditor

Coding Educator

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