RN, Transitions of Care & Quality Improvement

Conviva Care Solutions; Richardson (TX); On-site; USD 70,000 - 90,000; Full time

Job summary

Conviva Care Solutions in Richardson, TX, seeks an experienced Clinical Care Nurse (RN) to support transitions of care and improve Medicare Advantage Stars performance. The role blends patient education, outreach, and data-driven quality improvement across care settings.

Key responsibilities include post-discharge follow-up, care coordination, and collaboration with providers and the care team to reduce readmissions while enhancing patient outcomes and satisfaction.

Qualifications

• Must have ADN or BSN.
• Active, unrestricted RN license in Texas.
• 3+ years of clinical nursing with exposure to transitions of care, quality improvement, managed care, or population health management.
• Proficiency with electronic health records (e.g., Athena EMR), data analytics tools (DataHub, Compass Rose, Salesforce HealthCloud), and MS Office.
• Willing to complete and maintain Basic Life Support training.

Responsibilities

• Analyze clinical data from platforms to identify gaps in care related to Stars and HEDIS measures and TOC.
• Identify recently discharged patients and coordinate timely post-discharge follow-up per TOC/TCM.
• Conduct outreach via phone, telehealth and in-clinic visits to educate on preventive care and chronic disease management.
• Assess discharge instructions, medication reconciliation, symptom monitoring, and appointment adherence.
• Collaborate with interdisciplinary teams to implement evidence-based interventions and optimize workflows.

Skills

RN license TX

EHR (Athena)

Data analytics

TOC knowledge

Patient education

Education

ADN or BSN

Tools

Athena EMR

DataHub

Compass Rose

Salesforce HealthCloud

Microsoft Office

Job description

Conviva Care Solutions in Richardson, TX, seeks an experienced Clinical Care Nurse (RN) to support transitions of care and improve Medicare Advantage Stars performance. The role blends patient education, outreach, and data-driven quality improvement across care settings.

Key responsibilities include post-discharge follow-up, care coordination, and collaboration with providers and the care team to reduce readmissions while enhancing patient outcomes and satisfaction.