Clinical Quality Navigator

Anticipated End Date:

Clinical Quality Navigator

Care Bridge Health is a proud member of the Elevance Health family of companies, within our Carelon business. Care Bridge 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 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.

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.

• Assesses member’s 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 vendors 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.

• Requires a H.S. diploma or equivalent and a minimum of 1-year related outreach experience; or any combination of education and experience which would provide an equivalent background.

• 1+ years of experience in healthcare industry
• Microsoft Office proficiency (Word, Excel, PowerPoint & Outlook)
• Experience with clinical systems (electronic medical record, care management or population health management)
• Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or detailed information in a manner that others can understand, as well as ability to understand and interpret complex clinical information from others
• Familiarity with clinical quality (HEDIS/Stars)
• 1+ year of experience with EMR, medical records or patient‑facing interaction in any healthcare environment
• Certified nurse assistant or certified medical assistant and/or BS/BA degree in a related field preferred.
• Bilingual candidates preferred.

Non‑Management Non‑Exempt

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.

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.

At Elevance Health, we…