Remote RN Quality Care Coordinator (WI)

Network Health; Menasha (WI); Hybrid; USD 70,000 - 100,000; Full time

Job summary

Network Health is seeking a Quality Care Coordinator in Wisconsin to develop, implement, and monitor intervention plans aimed at reducing costs and improving quality scores. The role involves HEDIS and ongoing medical record reviews to ensure CMS/NCQA compliance.

Responsibilities include coordinating care management, supporting the appeals/grievance process, and collaborating with clinicians and programs to drive quality improvements. Travel to Menasha occasionally is required.

Qualifications

• Active Wisconsin RN licensure required.
• Associate Degree in Nursing required.
• Four+ years clinical health care experience as an RN required.

Responsibilities

• Engage with members/providers to close quality gaps per HEDIS/NCQA.
• Create member/provider materials (newsletters, brochures, handouts, letters, scripts).
• Coordinate member-centric programs in line with standards.
• Monitor utilization, records, and metrics for quality/efficiency.

Skills

RN licensure

Clinical health care experience

Education

Associate Degree in Nursing

Bachelor of Science in Nursing (preferred)

Job description

Network Health is seeking a Quality Care Coordinator in Wisconsin to develop, implement, and monitor intervention plans aimed at reducing costs and improving quality scores. The role involves HEDIS and ongoing medical record reviews to ensure CMS/NCQA compliance.

Responsibilities include coordinating care management, supporting the appeals/grievance process, and collaborating with clinicians and programs to drive quality improvements. Travel to Menasha occasionally is required.