Quality Improvement Specialist

Role Responsibilities

• Serve as a trusted partner to nephrology and primary or specialty practices on HEDIS and Stars expectations, documentation standards, and Evergreen’s value-based care priorities.
• Share and interpret quality reports, care gap lists, and dashboards, translating performance data into clear, practical improvement steps that align with Evergreen’s workflows and practice capabilities.
• Educate provider practices on documentation accuracy, coding completeness, and best practice workflows that directly impact HEDIS and Stars measure performance, including practice workflows timing and acceptable data sources.
• Facilitate recurring meetings with providers and practice staff to review quality trends, resolve workflow barriers, and co-develop action plans for performance improvement.
• Support provider adoption of Pay-for-Performance (P4P) components related to HEDIS and Stars by clarifying incentives, expectations, and measure specifications.
• Identify risks or gaps affecting measure outcomes and escalate as appropriate, and partner with internal teams to drive timely intervention.
• Manage an assigned panel of patients, monitoring and prioritizing HEDIS and Stars care gaps across preventive care, chronic disease management, and coordination of care.
• Conduct proactive patient outreach through phone, electronic and other approved communication channels to educate, motivate, and support patients to complete screenings, labs, immunizations, specialty appointments, and other recommended care.
• Reinforce provider directed care plans and ensure clear, timely communication between patients, practices and Evergreen care teams.
• Track outreach effectiveness, gap closure progress over time, and patient responsiveness, maintaining accurate and timely documentation of all patient interactions.
• Collaborate with Quality, Clinical Operations, Coding & Documentation, Practice Transformation, and Pharmacy to ensure payer aligned support for providers and patients.
• Participate in quality initiatives that are cross-functional and designed to improve performance at scale.
• Maintain accurate, timely documentation in EMRs and quality systems.
• Adhere to Evergreen’s compliance standards, HIPAA guidelines, and all regulatory requirements.

Required Qualifications

• 1-2 years of experience in quality improvement, population health, provider engagement, or care coordination
• Patient-facing outreach experience
• Understanding of quality workflows, gap closure processes, and documentation requirements
• Strong communication and relationship building skills
• EMR proficiency and familiarity with healthcare technology tools
• Intermediate skills with MS Office Suite of products including Outlook and Teams
• Able to work effectively in a primarily remote environment:
• Home internet must support a minimum download speed of 25 Mbps and upload speed of 10 Mbps. Cable, Fiber, or DSL connections hardwired to the internet device are recommended
• Evergreen will provide remote employees with telephony applications and equipment to meet the business requirements for their role
• Employees must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Preferred Qualifications

• Hands-on experience with HEDIS and Medicare Stars measures, including gap identification and closure workflows
• Experience in nephrology, CKD/ESRD, or chronic disease management
• Medical Assistant or LPN license
• Bachelor’s degree in health-related field preferred, or equivalent healthcare experience

Compensation

The pay range for this role is $20-$24/hr. Exact pay is determined based on experience, education, demand for the role, and other role-specific factors.

Benefits

• Paid time off starting at 4 weeks for full-time employees
• 12 paid holidays per year
• Medical, dental, vision and life insurance, including an HSA with employer match
• Reimbursement for continuing medical education for eligible roles
• A 401(k) program where Evergreen matches up to 4% of contributions
• Paid parental leave
• A robust training and development program that starts with onboarding and continues throughout your career with Evergreen Nephrology