RN Quality Navigator: Elevate Care, HEDIS & Stars

AdvantageCare Physicians; Hempfield Township (Westmoreland County); On-site; USD 81,000 - 96,900; Full time

Job summary

AdvantageCare Physicians is seeking a Quality Navigator to serve as an embedded clinical quality resource within NY-area practices. You will work with providers and care teams to close care gaps, optimize chronic disease management, and support transitions of care using analytics and Epic data to drive improvement.

The ideal candidate holds a BSN, NYS RN licensure, and at least two years of clinical experience, including ambulatory settings, with familiarity in Medicare Advantage,

Qualifications

• BSN is required.
• Current NYS RN licensure is required.
• Minimum of 2 years of clinical experience.
• Minimum of 1 year in an ambulatory setting.
• Experience with Medicare Advantage, Managed Care, Population Health, Quality Improvement, Care Management, or Value-Based Care.
• Experience supporting HEDIS, QARR, Stars, NCQA, or quality improvement programs.

Responsibilities

• Support quality improvement initiatives to enhance clinical outcomes.
• Ensure adherence to preventive care and clinical guidelines.
• Apply knowledge of HEDIS, QARR, and Stars specifications to guide interventions.
• Identify and prioritize patients with care gaps using analytics and registries.
• Execute proactive telephonic and digital outreach to drive preventive and chronic care adherence.
• Provide clinical support for care gap closure and document in Epic.
• Track and analyze outreach outcomes to inform quality improvement efforts.
• Reinforce best practices in communication, education, and follow-up.
• Ensure timely follow-up to improve continuity of care and patient satisfaction.

Skills

Clinical experience

Ambulatory setting

Analytical skills

Patient engagement

Communication

Education

BSN

RN licensure NYS

Tools

EMR systems

Population health platforms

Job description

AdvantageCare Physicians is seeking a Quality Navigator to serve as an embedded clinical quality resource within NY-area practices. You will work with providers and care teams to close care gaps, optimize chronic disease management, and support transitions of care using analytics and Epic data to drive improvement.

The ideal candidate holds a BSN, NYS RN licensure, and at least two years of clinical experience, including ambulatory settings, with familiarity in Medicare Advantage,