Quality Navigator (Registered Nurse)

About the role

This role involves serving as a clinical quality resource within provider practices to enhance Medicare Stars, HEDIS, QARR, and value-based care outcomes.

Responsibilities

• Support quality improvement initiatives and ensure adherence to clinical guidelines.
• Utilize analytics to identify care gaps and execute outreach to promote preventive and chronic care adherence.
• Provide clinical support for care gap closure and track outcomes to inform improvements.
• Enhance patient experience through effective communication, follow-up, and addressing CAHPS drivers.
• Support cost management by identifying high-risk patients and coordinating care to reduce avoidable utilization.
• Collaborate with care teams and connect patients to community resources for better health outcomes.

Requirements

• BSN and NYS RN licensure required.
• At least 2 years of clinical experience, including 1 year in an ambulatory setting.
• Experience with Medicare Advantage, Managed Care, Population Health, and quality programs such as HEDIS and Stars.
• Knowledge of chronic disease management, care coordination, and proficiency with EMR systems.
• Strong analytical, communication, and patient engagement skills.