Quality Improvement RN: Medicare/Medicaid Stars

Community Health Choice, Inc.; Houston (TX); On-site; USD 90,000 - 120,000; Full time

Job summary

Community Health Choice, Inc. is seeking a Quality Improvement Stars Clinical RN to strengthen quality performance across Medicare Advantage and Medicaid lines.

The role drives data‑informed initiatives, manages gap closure, and supports cross‑functional alignment to improve outcomes and compliance with quality measures. The RN must hold a Texas license and contribute to CMS Star Ratings efforts, with experience in HEDIS/CAHPS and provider education.

Qualifications

• Bachelor's degree in Public Health, Nursing, Healthcare Administration, or related field.
• Registered Nurse, current license within the state of Texas with active good standing.
• 3–5 years of experience in health plan quality improvement, Medicaid quality, or managed care, with 1 year in Quality Improvement.
• Familiarity with state CMS D-SNP model of care requirements.
• Strong knowledge of CMS Star Ratings, HEDIS, and CAHPS.

Responsibilities

• Track and support Stars performance across all Medicare Advantage quality domains (HEDIS, CAHPS, HOS, complaints, and appeals).
• Collaborate with analytics, care management, and provider relations to deploy targeted interventions.
• Assist in developing and disseminating provider educational materials and resources.
• Maintain documentation for audits, state reporting, and CMS compliance.
• Prepare dashboards, monthly performance summaries, and intervention tracking tools.

Skills

Communication

Relationship management

Organizational skills

Data visualization

CMS Star Ratings

Education

Bachelor's in Public Health

RN license (TX)

Master's in Public Health / Healthcare Management

CPHQ certification

Tools

Power BI

Tableau

Excel

Visio

Microsoft Office

Job description

Community Health Choice, Inc. is seeking a Quality Improvement Stars Clinical RN to strengthen quality performance across Medicare Advantage and Medicaid lines.

The role drives data‑informed initiatives, manages gap closure, and supports cross‑functional alignment to improve outcomes and compliance with quality measures. The RN must hold a Texas license and contribute to CMS Star Ratings efforts, with experience in HEDIS/CAHPS and provider education.