Job Summary

• The Health Plan Quality RN plays a key role in leading quality and performance improvement initiatives with a primary focus on CMS Medicare Star Ratings.
• This position is responsible for the identification, development, and implementation of strategic programs that enhance the health plan’s quality performance and regulatory compliance.
• The Quality RN provides clinical insight into appeals and grievances, oversees potential quality issues (PQIs), and collaborates across internal teams, provider partners, and external vendors to drive continuous improvement in quality, member outcomes, and satisfaction.

Matching Summary

Salary

Base: $64.91 per hour; Bonus/Equity: Not specified; Benefits: Not specified

Skills & Requirements

Key Requirements

• RN license state of California (unrestricted)
• At least 2 years of health plan experience in Quality
• At least 3 years of clinical practice experience
• CPHQ, CCM, or PMP certifications preferred

Work Rights