Quality Improvement - Clinical Quality Program RN (STARS) 195-2023

Community Care • Tulsa, OK

13d

About The Position

The Registered Nurse (RN) for Stars Quality promotes, protects, and improves the health of health plan members. The role develops and implements initiatives to manage chronic conditions, improve preventive care screenings, and close gaps in care, influencing quality performance metrics, particularly Medicare Advantage STARS ratings. The RN collaborates with interdisciplinary teams, providers, and community resources to support appropriate, high-quality, and cost-effective care.

Requirements

• Graduate from an accredited School of Nursing.
• Active, unrestricted Registered Nurse (RN) license in the state of employment or a compact state license.
• 2–3 years of clinical nursing experience, such as acute care, community health, or case management.
• Strong clinical assessment, critical thinking, and problem-solving skills.
• Excellent verbal and written communication, interpersonal, and patient engagement skills, including cultural competence.
• Proficiency in navigating EHR systems and other clinical software platforms.
• Ability to work independently, prioritize effectively, and collaborate within a multidisciplinary team.
• Ability to converse and write fluently in English.

Nice To Haves

• Bachelor's Degree in Nursing (BSN) preferred.
• Experience in a managed care environment or value-based care organization strongly preferred.
• Knowledge of HEDIS measures, STARS program requirements, or other quality metrics is a significant plus.

Responsibilities

• Monitor and track member data to identify and close gaps in preventive screenings and chronic disease management measures (HEDIS/STARS).
• Coordinate services across the continuum of care, including post-discharge follow-ups, to support seamless transitions and reduce preventable hospital admissions and readmissions.
• Engage members through methods such as phone and secure messaging to promote self-management goals, encourage adherence to treatment plans, and connect members with relevant community resources.
• Use electronic health records (EHR) and population health management systems to document patient interactions, monitor outcomes, analyze population data trends, and participate in quality improvement activities.
• Assist in educating network providers and office staff about population health initiatives, HEDIS/STARS measures, and practices for improving quality outcomes.
• Advocate for patients by helping members navigate the healthcare system and collaborating with social and behavioral health workers, community organizations, and other healthcare professionals to address social determinants of health and reduce disparities.
• Perform other job-related duties as assigned.

What This Job Offers

• Job Type: Full-time
• Education Level: Associate degree