RN Quality Care Coordinator — Remote WI

Milwaukee Succeeds; Town of Brookfield (WI); Hybrid; USD 70,000 - 90,000; Full time

Job summary

Network Health seeks a Quality Care Coordinator to develop, monitor, and improve intervention plans and quality gap closure. The role aims to reduce medical costs and improve quality ratings through member/provider engagement and coordinated clinical strategies.

Responsibilities include HEDIS reviews, creating member materials, and coordinating quality interventions with a focus on value-based care. RN licensure in Wisconsin is required.

Qualifications

• RN licensure in Wisconsin is required.
• BSN preferred for this role.
• Minimum four years clinical health care experience as an RN.

Responsibilities

• Provide direct outreach to members/providers to close quality gaps.
• Develop and coordinate member-centric programs aligned with standards.
• Monitor quality and efficiency via utilization patterns and metrics.
• Support appeals and grievance processes and medical director reviews.
• Present for Quality Management committee and trainings.

Skills

Quality improvement

HEDIS knowledge

Data analysis

Healthcare coordination

Communication skills

Education

Associate Degree in Nursing

Bachelor of Science in Nursing preferred

Tools

MS Excel

Job description

Network Health seeks a Quality Care Coordinator to develop, monitor, and improve intervention plans and quality gap closure. The role aims to reduce medical costs and improve quality ratings through member/provider engagement and coordinated clinical strategies.

Responsibilities include HEDIS reviews, creating member materials, and coordinating quality interventions with a focus on value-based care. RN licensure in Wisconsin is required.