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Salary: USD 20 - 24 / hourly
Evergreen Nephrology is transforming kidney care through a value-based, person-centered approach. As a Quality Improvement Specialist, you will serve as a connector between patients, provider practices, and internal teams to identify, manage, and close quality gaps through targeted education, consistent outreach, and data-driven collaboration.
You will manage a defined patient and provider panel, delivering actionable performance insights and driving improvement across HEDIS and Medicare Stars measures. The role requires effectiveness across patient engagement, provider coaching, workflow optimization, and cross-functional teamwork in a fast-paced, performance-oriented value-based care environment.
Key responsibilities include:
**Provider Engagement & Quality Education:** Serve as a trusted partner to nephrology and primary/specialty practices on HEDIS and Stars expectations, documentation standards, and Evergreen's value-based care priorities. Share and interpret quality reports, care gap lists, and dashboards, translating performance data into clear, practical improvement steps. Educate provider practices on documentation accuracy, coding completeness, and best-practice workflows. Facilitate recurring meetings with providers and practice staff to review quality trends, resolve workflow barriers, and co-develop action plans. Support provider adoption of Pay-for-Performance components and identify risks or gaps affecting measure outcomes.
**Patient Panel Management & Outreach:** Manage an assigned panel of patients, monitoring and prioritizing HEDIS and Stars care gaps across preventive care, chronic disease management, and coordination of care. Conduct proactive patient outreach through phone, electronic, and other approved communication channels to educate, motivate, and support patients in completing screenings, labs, immunizations, specialty appointments, and other recommended care. Identify and address patient-level barriers such as transportation, scheduling, care plan confusion, limited health literacy, or social barriers, leveraging internal resources and escalation pathways. Reinforce provider-directed care plans and ensure clear, timely communication between patients, practices, and Evergreen care teams. Track outreach effectiveness, gap closure progress, and patient responsiveness, maintaining accurate and timely documentation.
**Cross-Functional Collaboration & Compliance:** Collaborate with Quality, Clinical Operations, Coding & Documentation, Practice Transformation, and Pharmacy to ensure payer-aligned support for providers and patients. Participate in quality initiatives designed to improve performance at scale. Maintain accurate, timely documentation in EMRs and quality systems. Adhere to Evergreen's compliance standards, HIPAA guidelines, and all regulatory requirements.
**Requirements:**
- 1–2 years of experience in quality improvement, population health, provider engagement, or care coordination
- Patient-facing outreach experience
- Understanding of quality workflows, gap closure processes, and documentation requirements
- Strong communication and relationship-building skills
- EMR proficiency and familiarity with healthcare technology tools
- Intermediate skills with MS Office Suite (Outlook, Teams)
- Ability to work effectively in a primarily remote environment with minimum 25 Mbps download and 10 Mbps upload speeds; dedicated workspace required to protect PHI/HIPAA information
**Preferred Qualifications:**
- Hands-on experience with HEDIS and Medicare Stars measures, including gap identification and closure workflows
- Experience in nephrology, CKD/ESRD, or chronic disease management
- Medical Assistant or LPN license
- Bachelor's degree in health-related field or equivalent healthcare experience
