Quality Improvement Specialist
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Job Description
Quality Improvement Specialist advancing Evergreen Nephrology’s value-based kidney care through patient outreach and provider engagement. Closing HEDIS and Medicare Stars gaps through data-driven collaboration.
Responsibilities:
- Serve as the connector between patients, provider practices, and internal teams to identify, manage, and close quality gaps
- Manage a defined patient and provider panel
- Deliver actionable performance insights and drive improvement across HEDIS and Medicare Stars measures
- Partner with nephrology and primary or specialty practices on HEDIS and Stars expectations, documentation standards, and value-based care priorities
- Share and interpret quality reports, care gap lists, and dashboards
- Educate practices on documentation accuracy, coding completeness, and best-practice workflows
- Facilitate recurring meetings with providers and practice staff to review quality trends and co-develop improvement plans
- Support provider adoption of Pay-for-Performance components related to HEDIS and Stars
- Identify risks and gaps affecting measure outcomes and escalate appropriately
- Manage an assigned patient panel and prioritize care gaps across preventive care, chronic disease management, and care coordination
- Conduct proactive patient outreach by phone, electronic, and other approved channels
- Address patient barriers such as transportation, scheduling, care-plan confusion, limited health literacy, and other social barriers
- Reinforce provider-directed care plans and coordinate communication among patients, practices, and Evergreen care teams
- Track outreach effectiveness, gap closure progress, and patient responsiveness
- Maintain accurate and timely documentation in EMRs and quality systems
- Collaborate with Quality, Clinical Operations, Coding & Documentation, Practice Transformation, and Pharmacy teams
- Participate in cross-functional quality initiatives
- Adhere to compliance standards, HIPAA guidelines, and regulatory requirements
- Perform additional responsibilities aligned with value-based care and quality improvement objectives
Requirements:
- 1-2 years of experience in quality improvement, population health, provider engagement, or care coordination
- Patient-facing outreach experience
- Understanding of quality workflows, gap closure processes, and documentation requirements
- Strong communication and relationship-building skills
- EMR proficiency and familiarity with healthcare technology tools
- Intermediate skills with MS Office Suite, including Outlook and Teams
- Ability to work effectively in a primarily remote environment
- Home internet supporting at least 25 Mbps download and 10 Mbps upload; cable, fiber, or DSL hardwired connections recommended
- Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information
- Preferred: hands-on experience with HEDIS and Medicare Stars measures, including gap identification and closure workflows
- Preferred: experience in nephrology, CKD/ESRD, or chronic disease management
- Preferred: Medical Assistant or LPN license
- Preferred: Bachelor’s degree in a health-related field or equivalent healthcare experience
Benefits:
- Paid time off starting at 4 weeks for full-time employees
- 12 paid holidays per year
- Medical, dental, vision and life insurance, including an HSA with employer match
- Reimbursement for continuing medical education for eligible roles
- 401(k) program with Evergreen matching up to 4% of contributions after six months of tenure
- Paid parental leave
- Robust training and development program from onboarding throughout your career
- Annual bonus eligibility
- Remote employees receive telephony applications and equipment to meet business requirements
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