QI Stars Clinical RN

Community Health Choice; Houston (TX); On-site; USD 90,000 - 110,000; Full time

Job summary

Community Health Choice is seeking an experienced QI Stars Clinical RN to drive quality improvement across Medicare Advantage and Medicaid lines of business. You will combine clinical expertise with quality data and provider collaboration to improve health outcomes and close care gaps.

In this role you will advance CMS Medicare Advantage Star Ratings, develop gap-closure strategies, and help providers translate data into meaningful patient care improvements.

Qualifications

• Bachelor's degree in Nursing, Public Health, Healthcare Administration, or related field.
• Current RN license in Texas in good standing.
• 3–5 years in health plan quality improvement, Medicaid quality, managed care, or related environment.
• At least 1 year of direct Quality Improvement experience.
• Strong knowledge of CMS Star Ratings, HEDIS, and CAHPS.
• Experience presenting quality data to providers and supporting practice transformation.
• Strong analytical, communication, relationship-management, and organizational skills.
• Proficiency with MS Office and Visio.

Responsibilities

• Support quality improvement initiatives across Medicare Advantage and Medicaid with focus on CMS Part C Star Ratings.
• Analyze health plan quality data to identify trends, opportunities, and gaps in care.
• Develop and implement strategies to improve performance across Stars, HEDIS, and CAHPS.
• Lead and support gap-closure initiatives to improve preventive care and chronic condition management.
• Collaborate with providers to review quality performance and develop actionable strategies.
• Present clinical and quality data to providers to support transformation and improvement.
• Coordinate with internal teams to align quality initiatives and outreach.
• Monitor effectiveness of initiatives and adjust based on performance data.
• Ensure compliance with CMS requirements and Medicare/Medicaid quality standards.
• Build strong relationships with providers and internal stakeholders.

Skills

RN license Texas

Quality improvement

CMS Star Ratings

HEDIS

CAHPS

Data analysis

Provider collaboration

Communication

Microsoft Office

Data visualization

Education

Bachelor's degree in Nursing

Master's degree (preferred)

Tools

Tableau

Power BI

Excel

Visio

Word/PowerPoint

Job description

Turn Quality Data Into Better Health Outcomes

Community Health Choice is seeking an experienced QI Stars Clinical RN to help drive quality improvement across our Medicare Advantage and Medicaid lines of business.

In this role, you'll combine your clinical expertise with quality data and provider collaboration to improve health outcomes, close gaps in care, and strengthen performance across key quality measures. You'll play an important role in advancing CMS Medicare Advantage Star Ratings, developing gap-closure strategies, and helping providers translate quality data into meaningful improvements in patient care.

This is an opportunity for an RN with health plan or managed care quality experience who understands that behind every quality measure is a member whose health can be positively impacted.

Responsibilities:

• Support quality improvement initiatives across Medicare Advantage and Medicaid populations, with a focus on improving CMS Part C Star Ratings.
• Analyze quality performance data to identify trends, opportunities, and gaps in care.
• Develop and implement strategies to improve performance across Stars, HEDIS, CAHPS, and other applicable quality measures.
• Lead and support gap-closure initiatives designed to improve preventive care, chronic condition management, and member outcomes.
• Partner with providers and practices to review quality performance, identify improvement opportunities, and develop actionable strategies.
• Present clinical and quality data to providers in a clear, meaningful way that supports practice transformation and improved performance.
• Collaborate with internal teams to align quality initiatives, member outreach, provider engagement, and operational strategies.
• Monitor the effectiveness of quality improvement initiatives and recommend adjustments based on performance data.
• Support compliance with CMS requirements and applicable Medicare Advantage and Medicaid quality standards.
• Build productive relationships with providers and internal stakeholders to advance Community Health Choice's quality goals.

Required Qualifications:

• Bachelor's degree in Nursing, Public Health, Healthcare Administration, or a related field.
• Current Registered Nurse (RN) license in the State of Texas, active and in good standing.
• Three to five years of experience in health plan quality improvement, Medicaid quality, managed care, or a related healthcare environment.
• At least one year of direct Quality Improvement experience.
• Strong working knowledge of CMS Star Ratings, HEDIS, and CAHPS.
• Experience interpreting and presenting quality data to providers and supporting practice transformation or performance improvement.
• Strong analytical, communication, relationship-management, and organizational skills.
• Proficiency with Microsoft Office, including Word, Excel, PowerPoint, and Outlook, as well as Visio.

Preferred Qualifications:

• Master's degree in Public Health, Healthcare Management, or a related field.
• Certified Professional in Healthcare Quality (CPHQ) or other relevant clinical quality or public health certification.
• Familiarity with CMS D-SNP Model of Care requirements.
• Experience with data visualization and reporting tools such as Tableau or Power BI.

Bring Purpose to Quality Improvement

At Community Health Choice, quality isn't simply a score, it's about helping people receive the care they need to live healthier lives. As a QI Stars Clinical RN, you'll use your clinical knowledge, quality expertise, and relationships with providers to turn insights into action and help improve care for the communities we serve.

Purpose in Practice. It starts with you.

Community employees' benefits are provided by Harris Health. These benefits are designed to provide you with flexibility and options to meet your specific needs.

Community is an Equal Opportunity Employer.

Harris Health's benefits program is designed to provide you with greater flexibility and more choices to meet your specific needs. Harris Health's benefits program allows you to protect your income in case of illness, death, and disability, and to help you save for retirement.