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Posted 3 days ago
Requirements and responsibilities
Job Title: RN-Clinical Care Nurse/Utilization review
Duration: 3 plus month with possible extension
Location: Location: Work From Home (Virginia)
Location: Work From Home (Virginia)
Shift: M-F 8a-5p (local time)
Job Summary:
The Clinical Care Nurse (RN) is a clinic-based nursing role focused on improving patient
outcomes, supporting safe Transitions of Care (TOC), reducing avoidable ED utilization, and
driving Medicare Advantage Stars and quality performance.
The Clinical Care RN plays a critical role in advancing clinical quality, supporting patients across transitions of care, improving patient outcomes, and contributing to Medicare Advantage Stars
ratings by proactively identifying care opportunities, engaging patients and providers, and
driving evidence-based interventions.
This position balances direct patient education and outreach with data-driven quality
improvement efforts.
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.
Conduct targeted patient and provider outreach via phone and telehealth visits to close care opportunities, provide tailored education on preventive care, chronic disease management, and medication management.
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.
Optionally, you can add more information later (benefits, pre-screening questions, etc.)