Quality Improvement Specialist

As a Quality Improvement Specialist with Evergreen Nephrology, you will serve as the connector between patients, provider practices, and internal teams to identify, manage, and close quality gaps through targeted education, consistent outreach, and data-driven collaboration. This role manages a defined patient and provider panel, delivers actionable performance insights, and drives improvement across HEDIS and Medicare Stars measures using payer-specific specifications, timelines, and attribution logic.

The ideal candidate is effective across patient engagement, provider coaching, workflow optimization, and cross-functional teamwork, and is comfortable operating in a fast-paced, performance-oriented value-based care environment.

Role Responsibilities

• Provider Engagement, Quality Education & Measure Performance
  • Serve as a trusted partner to nephrology and primary or specialty practices on HEDIS and Stars expectations, documentation standards, and Evergreen’s value-based care priorities.
  • Share and interpret quality reports, care gap lists, and dashboards, translating performance data into clear, practical improvement steps that align with Evergreen’s workflows and practice capabilities.
  • Educate provider practices on documentation accuracy, coding completeness, and best practice workflows that directly impact HEDIS and Stars measure performance, including practice workflow timing and acceptable data sources.
  • Facilitate recurring meetings with providers and practice staff to review quality trends, resolve workflow barriers, and co-develop action plans for performance improvement.
  • Support provider adoption of Pay-for-Performance (P4P) components related to HEDIS and Stars by clarifying incentives, expectations, and measure specifications.
  • Identify risks or gaps affecting measure outcomes and escalate as appropriate, and partner with internal teams to drive timely intervention.
• Patient Panel Management, Outreach & Gap Closure
  • Manage an assigned panel of patients, monitoring and prioritizing HEDIS and Stars care gaps across preventive care, chronic disease management, and coordination of care.
  • Conduct proactive patient outreach through phone, electronic, and other approved communication channels to educate, motivate, and support patients to complete screenings, labs, immunizations, specialty appointments, and other recommended care.
  • The Quality Improvement Specialist plays a pivotal role in patient care coordination as the gateway to closing quality gaps and improving overall patient well-being.
  • Identify and address patient-level barriers such as transportation, scheduling, care plan confusion, or limited health literacy or other social barriers, leveraging internal resources and escalation pathways when appropriate.
  • Reinforce provider-directed care plans and ensure clear, timely communication between patients, practices, and Evergreen care teams.
  • Track outreach effectiveness, gap closure progress over time, and patient responsiveness, maintaining accurate and timely documentation of all patient interactions.
• Cross-Functional Collaboration & Compliance
  • Collaborate with Quality, Clinical Operations, Coding & Documentation, Practice Transformation, and Pharmacy to ensure payer-aligned support for providers and patients.
  • Participate in quality initiatives that are cross-functional and designed to improve performance at scale.
  • Maintain accurate, timely documentation in EMRs and quality systems.
  • Adhere to Evergreen’s compliance standards, HIPAA guidelines, and all regulatory requirements.
  • Perform additional responsibilities aligned with Evergreen’s value-based care and quality improvement objectives.
• Other duties consistent with this role, as assigned.