Stars Quality RN: Elevate Medicare Advantage Care

CommunityCare HMO Inc.; Tulsa (OK); On-site; USD 65,000 - 90,000; Full time

Job summary

CommunityCare HMO Inc. seeks a Registered Nurse to lead Stars Quality initiatives, improving preventive care, closing gaps in care, and boosting Medicare Advantage STARS ratings. You will collaborate with interdisciplinary teams to ensure high-quality, cost-effective care for members.

This role emphasizes population health, care coordination, and navigating social determinants of health to optimize outcomes and member experience within a managed care setting.

Qualifications

• Graduate from nursing program with RN licensure.
• BSN preferred; experience in managed care is a plus.
• Strong clinical judgment and care coordination skills.
• Experience using EHRs and clinical software for documentation.

Responsibilities

• Monitor and close gaps in care for preventive screenings and chronic disease management (HEDIS/STARS).
• Coordinate services across the care continuum and post-discharge follow-ups.
• Engage members via phone or secure messaging to support self-management.
• Document interactions in EHR and participate in quality improvement activities.
• Educate providers and staff on population health initiatives and quality metrics.
• Advocate for patients and address social determinants of health.

Skills

Clinical assessment

Critical thinking

Problem-solving

Communication skills

Cultural competence

EHR navigation

Education

Bachelor's Degree in Nursing (BSN) preferred

Tools

EHR systems

Clinical software

Job description

CommunityCare HMO Inc. seeks a Registered Nurse to lead Stars Quality initiatives, improving preventive care, closing gaps in care, and boosting Medicare Advantage STARS ratings. You will collaborate with interdisciplinary teams to ensure high-quality, cost-effective care for members.

This role emphasizes population health, care coordination, and navigating social determinants of health to optimize outcomes and member experience within a managed care setting.