Anticipated End Date:

2026-01-28

Position Title:

Clinical Quality Navigator II

Job Description:

JR179039 Clinical Quality Navigator II

CareBridge Health is a proud member of the Elevance Health family of companies, within our Carelon business. CareBridge Health exists to enable individuals in home and community-based settings to maximize their health, independence, and quality of life through homecare and community-based services.
 

The Clinical Quality Navigator II is responsible for ensuring that appropriate clinical data and documentation exists, as well as proactively identifying ways to improve the health of our members and meet clinical quality goals.

Location: Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions (when indicated), 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 accommodation is granted as required by law.
 

How you will make an impact:

Assesses members’ clinical quality needs and closure status via medical record review, clinical documentation collection or telephone.

Supports clinical team with resolution of barriers to ensure quality gap closure.

Support clinical team with member reminders for screenings and tests.

Coordinates follow-up care plan needs for members by scheduling appointments or enrolling members in programs.

Coordinates referral to local, state or federally funded programs.

Identifies opportunities that impact quality goals and recommends process improvements.

Medical record collection and review to support care plan needs of the member, including but not limited to outreach to other providers or facilities.

Medical record audit support to support HEDIS/Star program goals.

Prepares reports to document case and compliance updates.

Establishes and maintains relationships with agencies identified in appropriate contract.

Participates in cross-functional teams on projects, initiatives, and process improvement activities.

Support process improvement through the identification, verification and documentation of data source management processes, as well as development of associated action plans.

Subject matter expert in HEDIS/Star measures by providing guidance, education/training and support to program team members and clinical care team to ensure compliance with documentation requirements.

Minimum Requirements:

Requires a H.S. diploma or equivalent and a minimum of 3 years of related experience; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

Over 2 years of experience in the healthcare industry.

Proficient in Microsoft Office (Word, Excel, PowerPoint, and Outlook).

Experience working with clinical systems such as electronic medical records, care management, or population health management.

Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or detailed information in an understandable manner, and capable of understanding and interpreting complex clinical information from others.

Certification or licensure in a clinical or healthcare-related field, with at least 2 years of patient-facing experience.

More than 3 years of experience with electronic medical records, medical records, or patient-facing interaction in any healthcare environment.

At least 2 years of experience in clinical quality, specifically with HEDIS/Stars.

More than 2 years of experience in clinical data collection, abstraction, or validation.

Over 2 years of experience in the healthcare industry.

Proficient in Microsoft Office (Word, Excel, PowerPoint, and Outlook).

Experience working with clinical systems such as electronic medical records, care management, or population health management.

Certified nurse assistant or certified medical assistant and/or a BS/BA degree in a related field is preferred.

Bilingual candidates are preferred.

Job Level:

Non-Management Non-Exempt

Workshift:

Job Family:

MED > Care Coord & Care Mgmt (Non-Licensed)

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 is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.