QI Stars Clinical RN

Job Summary

The Quality Improvement Stars Clinical RN is responsible for supporting quality performance improvement across Community Health Choice's Medicare Advantage and Medicaid lines of business. This role focuses on improving Centers for Medicare and Medicaid Services (CMS) Part C Star Ratings. The Specialist drives data-informed initiatives, manages gap closure strategies, and supports cross-functional alignment to improve outcomes and compliance across all quality measures.

About the Role

Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.

Qualifications

• Education/Specialized Training/Licensure: Bachelor's degree in Public Health, Nursing, Healthcare Administration, or related field required. Registered Nurse, current license within the state of Texas. License must be active and in good standing required. Master's degree in Public Health or Healthcare Management or related field preferred. Certified Professional in Health Quality (CPHQ) preferred.
• Work Experience (Years and Area): 3-5 years of experience in health plan quality improvement, Medicaid quality, or managed care, with 1 year of Quality Improvement experience. Familiarity with state CMS D-SNP model of care requirements.
• Management Experience (Years and Area): N/A
• Software Proficiencies: Microsoft Office (Word, Excel, PowerPoint, Outlook) and Visio. Data visualization tools (e.g., Tableau, Power BI).
• Other: Strong working knowledge of CMS Star Ratings, HEDIS, and CAHPS. Experience presenting data to providers and supporting practice transformation. Excellent communication, relationship management, and organizational skills.