Job Summary

This position is responsible for supporting population health, quality improvement, and value-based care initiatives through close collaboration with provider groups, clinicians, and internal business partners. Responsibilities include embedded provider support, member outreach, care gap identification and closure activities, provider education, quality measure improvement, and implementation of clinical and operational strategies that enhance preventive care, improve health outcomes, and support value-based care objectives.

Required Job Qualifications

• Registered Nurse (RN) or Registered Physician Assistant (RPA) with current, unrestricted license in the state of operations.

• 2 years' experience using accreditation agency programs.

• 3 years of medical surgical and/or Quality Improvement and Utilization Review experience.

• 2 years of leadership or supervisory experience.

• Knowledge of medical terminology and procedures.

• Experience in using Total Quality Management (TQM)/Continuous Quality Improvement (CQI) concepts.

• Analytical skills to analyze data and prepare reports.

• Verbal and written communications skills in preparing recommendations and written documentation in appropriate format and facilitating work groups.

• Project management experience and skills

• PC experience utilizing Microsoft Windows based products and database experience.

Preferred Job Requirements

• Experience supporting population health, preventive care, or care management initiatives within a health plan, medical group, or healthcare system.

• Experience conducting provider and member outreach to improve quality outcomes and close gaps in care.

• Demonstrated success leading individuals in improving HEDIS, STAR, quality, or performance metrics through provider engagement and operational interventions.

• Experience working within provider offices, clinics, or health systems to implement quality improvement initiatives.

• Knowledge of value-based care, risk-based contracting, and population health management strategies.

• Prior leadership of quality consultants, clinical quality specialists, practice consultants, or population health teams.

• Experience leading large-scale quality or population health initiatives across multiple markets, provider groups, or regions.

• Experience collaborating with multidisciplinary teams to improve member engagement, access to care, and health outcomes.

• The ability to speak both the clinical language of providers and the operational language of health plan leadership.

• Medicare Stars and HEDIS expertise that goes beyond reporting and includes driving measurable improvement

• Experience reviewing and utilizing EMR data, care gap reports, and quality dashboards to drive performance improvement.

• Proven ability to build trusted relationships with physicians, practice administrators, and clinical staff.

• A track record of improving quality metrics through provider engagement rather than solely through internal analytics.

• Experience supporting practice transformation, workflow optimization, or clinical process improvement initiatives.

• Knowledge of preventive health measures, chronic disease management, and quality performance programs.

This is a fully work from home position, available in the US only, not limited to the posting location.

Sponsorship is not available

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

Base Pay Range
$84,400.00 - $152,300.00

Exact compensation may vary based on skills, experience, and location.