Quality Improvement Specialist

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

📋 Description

• Act as the liaison among patients, provider practices, and internal teams to pinpoint, manage, and resolve quality gaps.

• Oversee a designated patient and provider panel.

• Provide actionable performance insights and drive enhancements in HEDIS and Medicare Stars measures.

• Collaborate with nephrology and primary or specialty practices regarding HEDIS and Stars expectations, documentation standards, and value-based care priorities.

• Distribute and explain quality reports, care gap lists, and dashboards.

• Educate practices on the importance of documentation accuracy, coding completeness, and optimal workflow practices.

• Organize regular meetings with providers and practice staff to discuss quality trends and co-create improvement plans.

• Assist providers in adopting Pay-for-Performance components related to HEDIS and Stars.

• Identify risks and gaps impacting measure outcomes and escalate as necessary.

• Manage an assigned patient panel, prioritizing care gaps in preventive care, chronic disease management, and care coordination.

• Conduct proactive outreach to patients via phone, electronic means, and other authorized channels.

• Address patient barriers including transportation, scheduling, care-plan confusion, limited health literacy, and other social challenges.

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

• Monitor outreach effectiveness, progress in gap closure, and patient engagement.

• Ensure accurate and timely documentation in EMRs and quality systems.

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

• Engage in cross-functional quality initiatives.

• Comply with standards, HIPAA guidelines, and regulatory requirements.

• Undertake additional responsibilities aligned 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 requirements.

• Excellent communication and relationship-building skills.

• Proficiency in EMRs and familiarity with healthcare technology tools.

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

• Ability to effectively operate in a primarily remote environment.

• Home internet connection with at least 25 Mbps download and 10 Mbps upload; cable, fiber, or DSL hardwired connections are preferred.

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

• Preferred: hands-on experience with HEDIS and Medicare Stars measures, including gap identification and closure workflows.

• 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.

• Medical, dental, vision, and life insurance, including an HSA with employer match.

• Reimbursement for continuing medical education for eligible roles.

• 401(k) program with Evergreen matching up to 4% of contributions after six months of service.

• Paid parental leave.

• Comprehensive training and development program from onboarding throughout your career.

• Eligibility for annual bonuses.

• Remote employees receive telephony applications and equipment to fulfill business requirements.