Clinical Quality RN II

About the role

The Clinical Quality RN II, Member Experience reports to the Senior Director of Clinical Quality and is responsible for establishing, managing, and overseeing member-reported outcomes, including Net Promoter Score (NPS) detractors, grievances, and incidents. This role leads the development and maintenance of member experience policies and procedures and serves as a Process Improvement (PI) lead for company-wide initiatives. The Clinical Quality RN works cross-functionally across all Transcarent products, developing standardized processes and playbooks to drive consistency, efficiency, and continuous improvement.

The role plays a key role in developing enterprise-wide strategies to enhance the member experience through active monitoring and analysis of member-reported experience outcomes. This role ensures members receive best-in-class service across all programs, including Surgery Care, Oncology Care, Pharmacy PBM, VPC, and EMO services.

A day in the life…

• Lead Process Improvement Projects:
  Drive process improvement projects to standardize workflows across care products, ensuring efficient and effective responses to member feedback.
• Policies and Procedures Development:
  Develop, implement, and maintain policies and procedures related to member experience and service recovery
• .Documentation and Tracking:

Accurately capture, document, and track all member feedback, ensuring timely outreach and resolution of grievances in accordance with company policies and procedures.

• Dashboard and Reporting Development:
  Partner with Analytics to design and maintain dashboards and scorecards that track, trend, and analyze member feedback and experience outcomes..
• Insights and Presentation:
  Present member feedback trends, insights, and recommendations for improvement to committees and key stakeholders.
• Cross-Functional Collaboration:
  Collaborate with clinical teams, program managers, and clinical leaders to ensure member concerns are addressed in a coordinated and supportive manner.
• Customer Service Excellence:
  Demonstrate empathy, active listening, and effective problem-solving to consistently deliver a positive, high-quality member experience.

What we are looking for…

• Minimum of 5 years as an active Registered Nurse
• 3+ experience working in clinical quality, audit, or excellence.
• Strong and broad knowledge of the healthcare industry:
• Demonstrated broad understanding of current healthcare delivery systems
• Demonstrated ability to navigate/understand and explain Health Plan SPDs
• Commitment to quality and continuous improvement
• Demonstrated ability to use Microsoft Office (Word, Sharepoint, Powerpoint)
• Strong self-management
• Excellent written and verbal communication skills with proven ability to communicate with individuals at various levels within the organization
• Ability to perform well under pressure, adapt to change, and meet deadlines in a fast-paced, dynamic, evolving environment
• Proven critical thinking / problem solving
• Demonstrated attention to detail with a complement of strategic thinking
• Change champion and adapt to change quickly
• Data-driven and fact-based: focused on getting to best answer for clients
• Detail-oriented, inquisitive, problem-solving in nature
• A team player capable of working effectively with individuals throughout the organization

At Transcarent, our values guide everything we do:

• People First: We prioritize our Members, clients, and each other in every decision
• Care: Every decision starts with improving health and care for our Members
• Resilience: We push boundaries and take the uncharted path to change an industry
• Results: We take ownership, solve with speed, and deliver for our people and each other
• Humble and Human: We lead with humility, bring fun to tough moments, and go further together

Our benefits and perks programs include, but are not limited to:

• Competitive medical, dental, and vision coverage
• Competitive 401(k) Plan with a generous company match
• Flexible Time Off/Paid Time Off, 13 paid holidays
• Protection Plans including Life Insurance, Disability Insurance, and Supplemental Insurance
• Mental Health and Wellness benefits