RN Quality Care Coordinator

Network Health WI

. Develop, implement, and monitor intervention plans and quality gap closure .

Posted 10/28/2026full-timeMenasha • Wisconsin • United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical intervention strategies, quality improvement, and compliance with OCI, CMS, and NCQA standards. Proficient in conducting HEDIS reviews and developing member-centric programs to enhance population health outcomes.

Highest-signal resume keywords

Registered Nurse LicensureClinical Health Care ExperienceHEDIS Medical Record ReviewQuality ImprovementData Analysis

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical Intervention StrategiesQuality Gap ClosureUtilization Patterns EvaluationPreventive CareQuality Metrics MonitoringClinical Support for AppealsPolicy DevelopmentEvidence-Based Clinical GuidelinesMember OutreachCare Management Programs

Soft Skills

CollaborationCommunicationPresentation SkillsProblem-SolvingCustomer Engagement

Tools & Technologies

Clinical Integration ManualQuality Improvement ProjectsEducational Materials Development

Certifications & Qualifications

Bachelor of Science in NursingAssociate Degree in NursingRegistered Nurse Licensure in Wisconsin

Industry Keywords

OCI ComplianceCMS StandardsNCQA RequirementsHEDISPopulation Health

About the role

Key responsibilities & impact

Develop, implement, and monitor intervention plans and quality gap closure
Reduce medical costs and improve quality ratings through member/provider engagement and clinical intervention strategies
Conduct HEDIS and year-round medical record reviews
Ensure compliance with OCI, CMS, and NCQA quality requirements
Conduct direct outreach to members and providers to close quality gaps and support population health outcomes
Create member, physician, and customer materials, including newsletters, brochures, educational handouts, letters, and telephone scripts
Develop and coordinate member-centric programs aligned with industry and regulatory standards
Evaluate utilization patterns, medical records, and metrics to monitor quality and efficiency
Provide clinical support for appeals, grievances, and quality-of-care complaints
Identify improvement opportunities and implement clinical interventions
Prepare or deliver presentations for committees, clinics, and provider education
Coordinate, monitor, and document quality interventions and care management programs
Collaborate with secondary providers to coordinate member services
Liaise with families, members, and providers regarding current or potential issues
Develop, review, and revise department policies and procedures
Recommend and monitor preventive services and evidence-based clinical guidelines
Research, submit, and evaluate CMS-regulated quality improvement projects
Implement systems of care supporting early intervention
Assist with maintaining the Clinical Integration manual and related documentation and reports

Requirements

What you’ll need

Bachelor of Science in Nursing preferred
Associate Degree in Nursing required
Current registered nurse licensure in Wisconsin required
Minimum of four (4) years clinical health care experience as a Registered Nurse (RN) required
Experience in basic data analysis, quality improvement, HEDIS medical record review, preventive care, or health plan experience preferred
Candidates must reside in the state of Wisconsin
Reliable internet required for home office work
Occasional travel to the corporate office in Menasha required, including on the first day

Benefits

Comp & perks

Paid to volunteer in your local neighborhood
Home office work eligibility
Full-time schedule of 40 hours per week, 8am–5pm Monday through Friday