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Posted 4 days ago
Requirements and responsibilities
Job Title: RN- Clinical Care Nurse/Utilization Review- (Remote-Kansas/Missouri)
Duration:3 plus month with possible extension
Location: Work From Home (Kansas/Missouri)
Pay Range: $40-$45.00/HR
Must Be Licensed RN in Kansas or Missouri
Shift: M-F 8a-5p (local time)
This position balances direct patient education and outreach with data-driven quality improvement efforts.
Transitions: Care transition support, follow-up coordination, and avoidable readmission prevention for discharged inpatient, observation and emergency department patients
Quality: Medicare Advantage Stars, HEDIS and quality performance across value-based
Analyze clinical data and trends from platforms such as Athena EMR and DataHub to identify gaps in care related to HEDIS measures and Transitions of Care and post-hospitalization needs, prioritizing high-impact opportunities.
Proactively identify recently discharged inpatient, observation and emergency department patients and coordinate timely post-discharge follow-up in alignment with TOC and Transitional Care Management (TCM) requirements, with the aim of addressing root causes of utilization and supporting patients to prevent avoidable readmissions or return visits.
Required Qualifications:
• Bachelor’s degree in Nursing
• Active, unrestricted RN license (state-specific as applicable).
• Minimum of 3 years clinical nursing experience with exposure to transitions of care, quality improvement, managed care, or population health management.
Preferred Qualifications:
• Knowledge of Medicare Advantage Stars, HEDIS, CAHPS, and CMS quality requirements.
• Experience with Transitions of Care, hospital discharge or ER follow up programs.
• Proficiency with electronic health records (e.g., Athena EMR), data analytics tools (DataHub), and Microsoft Office Suite.
• Strong clinical judgment, data analysis skills, and ability to apply evidence-based practices.
Optionally, you can add more information later (benefits, pre-screening questions, etc.)