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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, data-driven collaboration, and consistent outreach.
You will manage a defined patient and provider panel, delivering actionable performance insights and driving improvement across HEDIS and Medicare Stars measures. Your responsibilities span two core areas:
Provider Engagement & Quality Education: Partner with nephrology and primary/specialty practices on HEDIS and Stars expectations, documentation standards, and value-based care priorities. Share and interpret quality reports, care gap lists, and dashboards, translating performance data into clear, practical improvement steps. Educate providers on documentation accuracy, coding completeness, and best-practice workflows that impact measure performance. Facilitate recurring meetings 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 outcomes.
Patient Panel Management & Outreach: Manage an assigned patient panel, monitoring and prioritizing HEDIS and Stars care gaps across preventive care and chronic disease management. Conduct proactive patient outreach via phone and electronic channels to educate, motivate, and support patients in completing screenings, labs, immunizations, and specialty appointments. Identify and address patient-level barriers such as transportation, scheduling, care plan confusion, health literacy gaps, and social determinants of health. Reinforce provider-directed care plans and ensure clear communication between patients, practices, and Evergreen care teams. Track outreach effectiveness and gap closure progress.
You thrive in innovative, fast-paced, performance-oriented environments with high rates of change. You are devoted, compassionate, and effective across patient engagement, provider coaching, workflow optimization, and cross-functional teamwork.
