Job Title: Clinical Quality RN

Location: 100% Remote

Duration: Contract-to-Hire position (3 months CTH).

Compensation: $25 - $35 per hour

Start Date: ASAP

About the Role:

Our client’s Home Pharmacy Stars Team delivers a range of services, including United HealthCare at Home (UAH) strategic Medication Adherence outreach, Care of Older Adults (COA) medication reviews and health assessments, SUPD/SPC provider consultations, Poly ACH and COB outreach, and targeted initiatives to improve Stars measures such as blood pressure and diabetes management. The team supports APC providers through clinical consultation services, with all services provided by Clinical Pharmacists, Pharmacy Technicians, and Clinical Quality RNs who engage with plan members and healthcare providers telephonically.

The Clinical Quality RN will report directly to the Senior Manager and play a key role in supporting medication adherence outreach, conducting telephonic patient assessments focused on Controlling Blood Pressure (CBP) and A1C measures, and educating patients on health conditions and the importance of routine screenings. This position requires meeting or exceeding established productivity and quality metrics and supporting the business hours of operation (Monday–Friday, 9am–5:30pm local time zone). The ideal candidate will have an active, unrestricted RN compact license, experience in managed care, strong knowledge of Medicare HEDIS/Stars measures, and excellent communication, problem-solving, and customer service skills. Proficiency in Microsoft Office (especially Excel) and the ability to work independently in a secure home environment are required. Call center experience, advanced degrees, and bilingual abilities are preferred.

What You'll Do:

• Conduct telephonic, patient-centered clinical consultations focused on Controlling Blood Pressure (CBP) and A1C measures
• Perform patient assessments for medication adherence outreach and core measures (MAC, MAD, MAH)
• Educate patients on health conditions, the necessity of routine screenings, and assist with appointment scheduling (A1C, CBP, Medication Adherence, etc.)
• Communicate with providers and offices to obtain evidence of completed lab work, screenings, and care provided
• Review available medical records for core measures and submit documentation for closure of HEDIS/Stars measures
• Assist patients with identification of and connectivity to community and program resources for non-medical needs
• Document thoroughly all calls and actions taken within core systems
• Adhere to department metrics, advanced protocols, and established scripting for telephonic outreach
• Meet or exceed established productivity and quality metrics
• Perform all other related duties as assigned

What You Bring:

• Active, unrestricted Registered Nurse eLNC Compact licensure in state of residency
• 1+ years of RN experience, including experience in a managed care setting
• Ability to review electronic medical records and charts
• Strong knowledge of Medicare HEDIS/Stars measures
• Demonstrated ability to interact with medical staff, peers, and internal company staff at all levels
• Ability to manage multiple complex, concurrent projects
• Excellent written and verbal communication and relationship-building skills
• Strong problem-solving skills; ability to analyze problems, draw relevant conclusions, and implement appropriate plans of action
• Proficient in Microsoft Office applications, especially Excel; experience with databases, word-processing, and Outlook
• Excellent customer service skills
• Designated secure and private workspace free of distraction, protecting HIPAA confidentiality (no childcare permitted during working hours)
• Access to install secure high-speed internet via cable/DSL at home
• 2+ years of call center experience (preferred)
• 2+ years of experience in HEDIS/Star programs, preferably in a clinical quality consultant role (preferred)
• Adaptable to change (preferred)
• Undergraduate degree preferred; postgraduate degree highly preferred
• Bilingual (Spanish, Vietnamese, Russian, Cantonese) (preferred)

Why Join Us?

• 401(k) Matching Plan
• Medical, Dental, & Vision Plans
• Relationship Driven Process to Find Your Best Fit
• 6 Paid Holidays
• Regular Meetings to Ensure Quality in Your Engagement

How to Apply:

Fill out the application below.