Quality Outreach RN - Care Coordinator at Tenavi Staffing

Position Summary

We are seeking an experienced and motivated Quality Outreach RN to join our team and play a key role in improving member outcomes and quality performance. The Quality Outreach RN will leverage clinical expertise and quality knowledge to conduct member outreach, close care gaps, and enhance overall member experience. This role is ideal for a nurse with a background in quality improvement, HEDIS, and managed care programs such as Medicare and CHIP.

Key Responsibilities

• Coordinate care across multiple providers and service settings to assist members in receiving timely, appropriate and continuous care.
• Monitor member progress and address barriers as needed to promote engagement and care coordination.
• Review and interpret medical records, claims data, and HEDIS measure criteria to identify actionable opportunities for intervention.
• Support the execution of quality improvement initiatives aimed at improving HEDIS and member experience performance.
• Document outreach efforts, barriers to care, and member engagement outcomes accurately and efficiently.
• Serve as a clinical resource for care teams and participate in cross-functional efforts to enhance quality reporting and compliance.
• Maintain confidentiality and adhere to all organizational, state, and federal regulatory requirements.

Qualifications

• Active, unrestricted RN (state-specific or compact license acceptable).
• HEDIS experience required, strong understanding of measure specifications, disease management, and gap closure strategies.
• Experience with Medicare and/or CHIP populations is strongly preferred.
• Minimum of 3-5 years of clinical experience in managed care, quality improvement, or population health.
• Strong communication, organization, and analytical skills.
• Proficiency with electronic health records, data entry, and reporting tools.