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.

• 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.

• Minimum of 5 years as an active Registered Nurse
• 3+ years of 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

As a remote position, the salary range for this role is: $95,000 — $105,000 USD

Transcarent is the One Place for Health and Care™, bringing medical, pharmacy, and point solutions together with the Way Finding™ experience, the first and only generative AI-powered health and care platform for health consumers. Our Way Finding experience, paired with transparent and consumer-driven pharmacy care, 2nd.

MD expert medical opinions, and virtual primary care, works seamlessly with comprehensive Care Experiences – Cancer Care, Surgery Care, and Weight Health – to support people with all of their health needs, simple or serious. More than 1,700 employers and health plans rely on us to provide information, guidance, and care, empowering health consumers with more choice, an experience they love, access to higher-quality care, and lower costs for 21 million…