Registered Nurse Medicare Program Lead

Job Summary

To lead operational initiatives in Medicare Advantage Quality and Risk Adjustment, the full-time Registered Nurse Medicare Program Lead will coordinate HEDIS reporting, manage vendor relationships, and ensure compliance with regulatory standards while working remotely.

Key responsibilities

• Coordinate annual HEDIS reporting activities and manage quality improvement initiatives
• Oversee risk adjustment program operations, including chart retrieval and vendor management
• Produce and distribute provider performance reports, ensuring data accuracy and compliance

Required qualifications

• Active, unrestricted Registered Nurse License
• Bachelor's degree in Nursing, Healthcare Administration, Public Health, or a related field
• 2+ years of health plan experience in Medicare Advantage Quality, HEDIS, or Risk Adjustment operations
• 3+ years of clinical practice experience in acute, ambulatory, or managed care settings
• Familiarity with CMS Medicare Advantage regulations and NCQA HEDIS audit processes