Quality Improvement RN for Medicare Stars

Harris Health; Houston (TX); On-site; USD 80,000 - 110,000; Full time

Job summary

Community Health Choice, Inc. is seeking a Quality Improvement Stars Clinical RN to enhance CMS Part C Star Ratings across Medicare Advantage and Medicaid lines. You will lead data-driven initiatives, close gaps in care, and align teams to improve outcomes and compliance.

The role focuses on supporting CMS Star Ratings programs, provider education, and cross-functional execution of quality improvement projects within a nonprofit health plan affiliated with Harris Health System.

Qualifications

• Bachelor's degree in Public Health, Nursing, Healthcare Administration, or related field required.
• RN license in Texas current and active.
• Master's degree preferred.
• CPHQ certification preferred.

Responsibilities

• Track and support Stars performance across Medicare Advantage quality domains (HEDIS, CAHPS, HOS, complaints, and appeals).
• Collaborate with analytics, care management, and provider relations to deploy targeted interventions.
• Develop and disseminate member outreach materials.
• Support member experience improvement activities including CAHPS training and call quality reviews.
• Maintain documentation for audits, state reporting, and CMS compliance.
• Prepare dashboards and monthly performance summaries; assist in interventions tracking.

Skills

Communication

Relationship management

Organizational skills

Data interpretation

Education

Bachelor's degree in Public Health, Nursing, Healthcare Administration, or related field

Registered Nurse license in Texas

Master's degree in Public Health or Healthcare Management

CPHQ certification

Tools

Tableau

Power BI

Visio

Microsoft Excel

Job description

Community Health Choice, Inc. is seeking a Quality Improvement Stars Clinical RN to enhance CMS Part C Star Ratings across Medicare Advantage and Medicaid lines. You will lead data-driven initiatives, close gaps in care, and align teams to improve outcomes and compliance.

The role focuses on supporting CMS Star Ratings programs, provider education, and cross-functional execution of quality improvement projects within a nonprofit health plan affiliated with Harris Health System.