RN Disease Mgmt - Clinical Quality (HEDIS) - CareBridge

Anticipated End Date: 2026-03-31 Position Title: RN Disease Mgmt - Clinical Quality (HEDIS) - CareBridge Job Description: Nurse Disease Management I LOCATION: This is a virtual eligible role. You should be within a reasonable distance of one of our offices. HOURS: 8:00am - 5:00 pm, local time. Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Responsible for participating in delivery of patient education and disease management interventions and for performing health coaching for members, across multiple lines, for health improvement/management programs for chronic diseases. This position focuses on assessing member compliance and closing HEDIS® care gaps. Evaluate adherence to treatment plans via phone outreach and medical record reviews, lead and support efforts to meet or exceed HEDIS®/Stars goals, identifying opportunities to improve quality outcomes, and recommending process improvements, and coaching others to master HEDIS® guidelines. Primary duties may include, but are not limited to:

• Conducts behavioral or clinical assessments to identify individual member knowledge, skills and behavioral needs. Identifies and/or coordinates specific health coaching plan needs to address objectives and goals identified during assessments.
• Interfaces with provider and other health professionals to coordinate health coaching plan for the member.
• Implements and/or coordinates coaching and/or care plans by educating members regarding clinical needs and facilitating referrals to health professionals for behavioral health needs. Uses motivational interviewing to facilitate health behavior change.
• Monitors and evaluates effectiveness of interventions and/or health coaching plans and modifies as needed.
• Directs members to facilities, community agencies and appropriate provider/network.

Required Qualifications

• Requires AS in nursing and minimum of 2 years of condition specific clinical or home health/discharge planning experience; or any combination of education and experience, which would provide an equivalent background.
• Current unrestricted RN license in applicable state(s) required.

Preferred Qualifications

• 2+ years HEDIS MRRV experience is a must for this role.
• HEDIS® technical specifications knowledge/experience is a must for this role.
• RN compact license is strongly preferred.
• Experience working with members that have chronic diseases is strongly preferred.
• BS/BA degree in nursing or a healthcare related field is preferred.
• Experience working in home health or care management is preferred.
• Bilingual skills are very helpful.

Job Level: Non-Management Exempt Workshift: 1st Shift (United States of America) Job Family: MED > Licensed Nurse Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities Apply tot his job Apply To this Job