Experience in Medicare Advantage, Managed Care, Population Health, Quality Improvement, Care Management, or Value-Based Care
Familiarity with HEDIS, QARR, Stars, NCQA, or quality improvement programs
Strong analytical, communication, and patient engagement skills.
Responsibilities
Support quality improvement initiatives to enhance clinical outcomes and care delivery.
Ensure adherence to preventive care and clinical guidelines across assigned measures.
Apply knowledge of HEDIS, QARR, and Stars specifications to guide interventions.
Identify and prioritize patients with care gaps using analytics, registries, and HEDIS checklists.
Execute proactive telephonic and digital outreach to drive preventive and chronic care adherence.
Track and analyze outreach outcomes to inform quality improvement efforts.
Partner with providers and interdisciplinary teams to support care delivery.
Benefits
Embedded clinical role providing direct impact on patient care
Opportunities for collaboration with various healthcare professionals
Focus on quality improvement initiatives and patient engagement
Involvement in community health to enhance access to resources
Full Job Description
Summary of Position
The Quality Navigator serves as an embedded clinical quality resource within assigned provider practices to improve Medicare Stars, HEDIS, QARR, and value-based care performance outcomes. The role partners directly with providers, office leadership, care management teams, and interdisciplinary stakeholders to identify and close care gaps, optimize chronic disease management, improve patient engagement, support care transitions, and drive practice-level quality improvement initiatives. The Quality Navigator utilizes clinical expertise, analytics, and performance data to improve member outcomes, enhance patient experience, and achieve organizational quality goals
