Clinical Quality Coordinator, RN

This is a fully remote position, open to applicants in Florida.

📋 Description

• Inform members about essential screenings, such as diabetic and breast cancer screenings.

• Motivate members to arrange appointments and provide assistance with scheduling when necessary.

• Conduct assessments, including the Conditions of Older Adults evaluation.

• Perform outreach to members, engage with providers, and review charts to aid in closing HEDIS care gaps.

• Coordinate services among primary care physicians (PCPs), specialists, medical providers, and non-medical personnel.

• Deliver educational resources to patients and providers.

• Help facilitate member access to community-based services.

• Identify and report on quality concerns related to risk management.

• Assist in closing care gaps directly through member outreach, assessment, and documentation.

• Provide clinical support to outreach coordinators assisting high-risk members and/or providers.

• Aid in quality initiatives and outreach efforts directed at noncompliant members.

• Manage a caseload while educating members and guardians through activities aimed at closing care gaps.

• Adapt to evolving outreach campaigns, priorities, and processes.

• Carry out additional duties as assigned.

⛳️ Requirements

• A Bachelor's Degree in Nursing is required.

• A minimum of 2 years of Clinical Nursing experience in an acute care environment is required.

• At least 1 year of experience in case management or quality improvement within a managed care setting is required.

• RN - Registered Nurse - State Licensure and/or Compact State Licensure is required.

• A Master's Degree in Nursing is preferred.

• Experience with government-sponsored managed care programs is preferred.

• Must have the ability to work from home in the Eastern or Central time zone.

• Availability approximately from 8:00 a.m. to 5:00 p.m., with adjustments based on your time zone and business requirements.

• Must comply with all policies and standards.

🏝️ Benefits

• Health insurance.

• 401K.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off in addition to holidays.

• Flexible work arrangements, including remote, hybrid, field, or office schedules.

• Additional forms of incentives may be included in total compensation.