Quality Improvement Specialist

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

📋 Description

• Act as a reliable partner to nephrology and primary or specialty practices regarding HEDIS and Stars expectations, documentation standards, and value-based care priorities.

• Analyze and communicate quality reports, care gap lists, and dashboards, converting performance data into actionable improvement strategies.

• Educate provider practices on the importance of documentation accuracy, comprehensive coding, and optimal workflows that impact HEDIS and Stars performance.

• Organize regular meetings with providers and practice staff to discuss quality trends, overcome workflow challenges, and collaboratively develop action plans.

• Assist provider adoption of Pay-for-Performance elements related to HEDIS and Stars.

• Identify risks or gaps impacting measure outcomes, escalate as needed, and collaborate with internal teams on interventions.

• Manage a designated patient panel while prioritizing HEDIS and Stars care gaps.

• Perform proactive patient outreach through phone, electronic means, and other approved channels.

• Address patient challenges such as transportation issues, scheduling conflicts, confusion over care plans, limited health literacy, and social barriers.

• Reinforce provider-directed care plans and coordinate communication among patients, practices, and Evergreen care teams.

• Monitor outreach effectiveness, gap closure, and patient engagement; accurately document patient interactions in a timely manner.

• Collaborate with Quality, Clinical Operations, Coding & Documentation, Practice Transformation, and Pharmacy departments.

• Engage in cross-functional quality initiatives.

• Maintain accurate documentation within EMRs and quality systems.

• Comply with standards, HIPAA regulations, and other regulatory requirements.

• Undertake additional responsibilities that align with value-based care and quality improvement goals.

⛳️ Requirements

• 1–2 years of experience in quality improvement, population health, provider engagement, or care coordination.

• Experience in patient-facing outreach.

• Knowledge of quality workflows, gap closure processes, and documentation standards.

• Excellent communication and relationship-building abilities.

• Proficient in EMR systems and familiarity with healthcare technology tools.

• Intermediate skills in MS Office Suite, including Outlook and Teams.

• Capability to work efficiently in a predominantly remote setting.

• Reliable home internet with a minimum of 25 Mbps download and 10 Mbps upload; cable, fiber, or DSL hardwired connections are preferred.

• A dedicated workspace free from ongoing interruptions to safeguard member PHI/HIPAA information.

• Preferred: hands-on experience with HEDIS and Medicare Stars measures.

• Preferred: experience in nephrology, CKD/ESRD, or chronic disease management.

• Preferred: Medical Assistant or LPN license.

• Preferred: Bachelor’s degree in a health-related field or equivalent healthcare experience.

🏝️ Benefits

• Paid time off starting at 4 weeks for full-time employees.

• 12 paid holidays each year.

• Comprehensive medical, dental, vision, and life insurance, including an HSA with employer matching.

• Reimbursement for continuing medical education for eligible positions.

• A 401(k) plan with Evergreen matching up to 4% of contributions.

• Paid parental leave.

• A comprehensive training and development program that begins with onboarding and continues throughout your career at Evergreen Nephrology.

• Eligibility for annual bonuses.

• Evergreen will supply remote employees with telephony applications and equipment necessary to fulfill the business requirements of their roles.