RN - Transitions of Care & Quality Improvement

CenterWell Senior Primary Care; Jackson (MS); On-site; USD 64,000 - 88,000; Full time

Benefits offered by this job

Medical, dental, vision benefits

401(k) retirement plan

Paid time off

Job summary

CenterWell Senior Primary Care is seeking a Clinical Care Nurse (RN) to support safe transitions of care and improve Medicare Advantage Stars in Mississippi. The role focuses on post-discharge follow-up, patient education, and data-driven quality improvement within clinic teams.

The ideal candidate will have an ADN or BSN, an active MS RN license, 3+ years of nursing experience, and proficiency with Athena EMR and data tools. In-center schedule requires daily presence, with travel as needed.

Qualifications

• ADN or BSN required.
• Active RN license in Mississippi.
• 3+ years of clinical nursing experience with transitions of care or population health.
• Proficiency with electronic health records and data analytics tools.
• Willing to complete Basic Life Support training.

Responsibilities

• Analyze clinical data to identify gaps in care and opportunities for Stars/HEDIS improvement.
• Coordinate timely post-discharge follow-up to prevent readmissions.
• Educate patients and caregivers via phone, telehealth, and in-clinic visits.
• Document outreach and outcomes in CMS-compliant systems.
• Collaborate with interdisciplinary teams to improve workflows and care quality.

Skills

Clinical nursing

Transitions of care

Patient education

Quality improvement

Data analysis

Education

ADN

BSN

Tools

Athena EMR

DataHub

Compass Rose

Salesforce HealthCloud

Microsoft Office

Job description

CenterWell Senior Primary Care is seeking a Clinical Care Nurse (RN) to support safe transitions of care and improve Medicare Advantage Stars in Mississippi. The role focuses on post-discharge follow-up, patient education, and data-driven quality improvement within clinic teams.

The ideal candidate will have an ADN or BSN, an active MS RN license, 3+ years of nursing experience, and proficiency with Athena EMR and data tools. In-center schedule requires daily presence, with travel as needed.