Quality Clinician

License or Certification Required: Active, unrestricted clinical license (e.g., RN, LPN/LVN, NP, PA) or an equivalent recognized clinical certification reflecting formal clinical education. Must be in good standing. Organization Information At Gellert Health, our mission is to Bring Care Back to Healthcare. We offer an unparalleled concierge level of health navigation and advocacy, striving for excellence in care. Our foundation is built on kindness, integrity, and quality, values that resonate in our dedication to the community, patients, partners, and our team members. Gellert Health is committed to integrating cultural competence and the principles of trauma-informed care into our services. Gellert Health has transformed healthcare for the most vulnerable and underserved populations by providing Health Navigation Services aimed at enhancing both physical and behavioral health outcomes for patients. Our focus lies in addressing the primary barriers to quality healthcare, which include supporting patients in understanding and navigating the healthcare system and ensuring access to safe and reliable transportation. Position Summary The Quality Clinician is responsible for clinical quality oversight, ensuring patients are receiving appropriate, evidence-based navigation and care coordination. This role uses clinical training and judgment to review charts, identify and monitor HEDIS care gaps, evaluate quality of care, and partner with providers and multidisciplinary stakeholders to close gaps and improve patient outcomes. The Quality Clinician also facilitates and participates in patient case conferences and clinical reviews with internal and external partners, which may include hospitals, clinics, primary and specialty care providers, social service organizations, health plans and insurance payers, and other community or healthcare partners. These activities require clinical assessment, coordination, communication, and follow-through to support appropriate care planning, address barriers to care, and promote continuity and quality of care. Essential Duties and Responsibilities Conduct navigation quality audits and chart reviews requiring formal clinical training and judgment. Identify and monitor HEDIS care gaps; track closure and support measure performance and quality improvement initiatives. Review clinical documentation against evidence-based standards and identify missed screenings, preventive care, and chronic care management opportunities. Review clinical outcomes and patterns to identify trends or areas of concern. Identify potential patient safety or quality of care concerns and elevate significant patient outcome issues to appropriate leadership. Facilitate and participate in patient case conferences, clinical reviews, and multidisciplinary care discussions involving internal and external stakeholders. Collaborate with hospitals, clinics, providers, social service agencies, insurance payers/health plans, and other healthcare or community partners to review patient needs, address barriers to care, coordinate services, and identify opportunities to improve outcomes. Communicate relevant clinical findings, patient status updates, care needs, and recommended interventions during case conferences and clinical reviews. Collaborate with external providers and clinical teams on identifying and closing gaps in care. Recommend interventions and quality improvement opportunities based on audit findings, clinical reviews, and identified care gaps. Document case conference outcomes, clinical recommendations, follow-up needs, and other quality-related activities in accordance with organizational requirements. Maintain current knowledge of HEDIS specifications, clinical guidelines, evidence-based practices, and quality measure updates. Qualifications Active, unrestricted clinical license (e.g., RN, LPN/LVN, NP, PA) or an equivalent recognized clinical certification reflecting formal clinical education. Must be in good standing. Years of clinical experience as determined by the organization; managed care, ambulatory care, hospital care, care coordination, or population health experience preferred. Working knowledge of HEDIS measures and quality of care review standards. Experience with chart review and clinical audit strongly preferred. Strong clinical judgment and ability to identify gaps in care independently. Experience participating in or facilitating multidisciplinary case conferences, care reviews, or care coordination activities preferred. Comfortable interfacing directly with providers, hospitals, clinics, social service organizations, health plans/insurance payers, and other healthcare partners regarding patient status, care needs, and follow-up. Ability to communicate clinical information effectively across multidisciplinary teams and organizational settings. Skills and Competencies Clinical assessment and critical thinking. Familiarity with EHR systems and chart abstraction. Strong written and verbal communication, particularly in provider-facing and multidisciplinary conversations. Ability to facilitate clinical discussions and communicate patient needs and recommendations to diverse stakeholders. Ability to coordinate follow-up across multiple organizations and service providers. Ability to work independently and prioritize a caseload of reviews, quality activities, and patient case conferences. Strong organizational skills and attention to detail. Working Conditions Office based, 40 hours a week, in office (85020) #J-18808-Ljbffr Gellert Health