Remote RN Quality Care Coordinator—Wisconsin

Network Health; Town of Brookfield (WI); Hybrid; USD 65,000 - 90,000; Full time

Job summary

Network Health is seeking a Quality Care Coordinator to lead initiatives that reduce costs and improve quality ratings. You will monitor intervention plans, conduct HEDIS reviews, and ensure compliance with OCI, CMS and NCQA requirements.

The role requires Wisconsin RN licensure, at least four years of clinical RN experience, and collaboration with providers and internal teams. This position involves office and home-based work with occasional travel to the corporate office for onboarding and

Qualifications

• RN licensure in Wisconsin is required.
• Minimum four years of clinical RN experience.
• Experience with data analysis, quality improvement or HEDIS medical record review preferred.
• Bachelor's degree in Nursing preferred.

Responsibilities

• Provide direct outreach to members and/or providers to close quality gaps.
• Create written materials for members and physicians.
• Coordinate member-centric programs in line with standards.
• Evaluate utilization patterns and records to monitor quality.
• Support appeals and quality of care processes for medical director review.
• Identify opportunities for improvement and implement interventions.
• Prepare and present to Quality Management committees and education sessions.
• Coordinate quality interventions and care management for value-based care.

Skills

Data analysis

Quality improvement

HEDIS review

Education

Associate Degree in Nursing

Bachelor of Science in Nursing (preferred)

Job description

Network Health is seeking a Quality Care Coordinator to lead initiatives that reduce costs and improve quality ratings. You will monitor intervention plans, conduct HEDIS reviews, and ensure compliance with OCI, CMS and NCQA requirements.

The role requires Wisconsin RN licensure, at least four years of clinical RN experience, and collaboration with providers and internal teams. This position involves office and home-based work with occasional travel to the corporate office for onboarding and