About the job
Position: Clinical Quality RN
Location: 100% Remote
Duration: Through end of 2025
Start Date: ASAP
Job Description
A national healthcare organization is seeking a Clinical Quality RN to join a remote care management team focused on improving health outcomes and quality measures. This team supports various strategic outreach initiatives, including medication adherence, health assessments, provider consultations, and clinical member engagement for improved Stars and HEDIS performance.
As a Clinical Quality RN, you will work in a telephonic environment performing patient-centered clinical consultations primarily focused on Controlling Blood Pressure (CBP) and Hemoglobin A1C (A1c) measures. You will be part of a multidisciplinary team including Clinical Pharmacists and Pharmacy Technicians.
Work Schedule: Monday to Friday, 9:00 AM – 5:30 PM (local time zone)
Primary Responsibilities
- Perform telephonic outreach using department protocols and scripts
- Complete assessments for CBP and A1C measures, as well as medication adherence (MAC, MAD, MAH)
- Educate patients on chronic condition management and help schedule needed lab tests or provider visits
- Collaborate with provider offices to obtain lab results, medical records, and other evidence of care
- Review and abstract clinical data to close care gaps for HEDIS/STARS measures
- Assist patients in accessing community resources for non-clinical support
- Accurately document all outreach and care coordination in electronic systems
- Support clinical consultation services as needed
- Other related duties as assigned
Required Qualifications
- Active, unrestricted Compact RN license in state of residence
- 1+ years of RN experience, preferably in a managed care setting
- Experience reviewing electronic medical records (EMRs)
- Solid understanding of Medicare HEDIS/Stars measures
- Strong interpersonal and collaboration skills
- Effective problem-solving and critical-thinking abilities
- Proficiency with Microsoft Office Suite, especially Excel
- Strong written and verbal communication skills
- Must have a private, secure home workspace (HIPAA compliant; no childcare allowed during work hours)
- Must have access to high-speed internet (cable/DSL only)
Preferred Qualifications
- 2+ years of call center experience
- 2+ years of direct experience with HEDIS/Stars programs, ideally in a clinical quality role
- Undergraduate degree preferred; advanced degree highly preferred
- Bilingual in Spanish, Vietnamese, Russian, or Cantonese
- Adaptability and comfort working in a fast-changing environment