QI Stars Clinical RN — Elevate Medicare Advantage Quality

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

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.