Remote Clinical Quality RN – Compact License

Job Title: Clinical Quality RN

Contract Length: 3 months; initial contract through December 31, 2026

Location: 100% Remote

Hours: Monday–Friday, 9:00 AM–5:30PM EST

Start Date: October 5, 2026

Client Overview:

Our client’s Home Pharmacy Stars Team supports strategic clinical quality initiatives focused on improving patient outcomes and closing care gaps. The team partners with Clinical Pharmacists, Pharmacy Technicians, Clinical Quality RNs, healthcare providers, and plan members to support medication adherence, preventive care, and key HEDIS/Stars measures.

Job Description:

The Clinical Quality RN will support member outreach and clinical quality initiatives designed to close care gaps and improve Stars measure performance. This position will conduct telephonic patient assessments and clinical consultations focused on measures such as Controlling Blood Pressure (CBP) and A1C, medication adherence, and other core HEDIS/Stars measures.

The RN will educate patients on health conditions and the importance of routine screenings, assist with appointment scheduling, communicate with healthcare providers to obtain documentation of completed care, and review medical records to identify opportunities for measure closure. The role will also assist patients with connecting to appropriate community and program resources.

This position requires strong clinical judgment, excellent communication skills, thorough documentation, and the ability to meet established productivity and quality metrics while working independently in a fully remote environment.

Skill Set Requirements:

• Active, unrestricted RN license with compact/eLNC licensure in state of residency
• Minimum 1 year of RN experience
• Phone, sales, or customer service experience
• Case management experience
• Experience in a managed care setting
• Strong knowledge of Medicare HEDIS/Stars measures
• Ability to review electronic medical records and patient charts
• Strong written and verbal communication skills
• Excellent customer service and relationship-building skills
• Strong problem-solving and analytical abilities
• Ability to manage multiple complex, concurrent projects
• Proficiency with Microsoft Office, particularly Excel
• Ability to meet or exceed established productivity and quality metrics
• Ability to work independently while following established protocols and scripting
• Designated secure, private workspace free of distractions and compliant with HIPAA confidentiality requirements
• Reliable high-speed internet via cable/DSL
• Strong documentation and organizational skills

Nice to Haves:

• 2+ years of call center experience
• 2+ years of experience working with HEDIS/Stars programs
• Previous experience in a Clinical Quality Consultant role
• Experience with medication adherence outreach
• Experience conducting telephonic patient assessments
• Experience with provider/clinical office outreach
• Adaptability and comfort working in a changing environment
• Bilingual in Spanish, Vietnamese, Russian, or Cantonese

Education/Certification(s)/License(s):

• Active, unrestricted Registered Nurse (RN) license with compact/eLNC licensure required
• Undergraduate degree preferred
• Postgraduate degree highly preferred