Clinical Quality & Medicare Performance Nurse (LPN/RN Required) Full‑Time | Field‑Based Role (Travel Required) Summary This position plays a key role in supporting Primary Care physicians with Medicare Advantage performance, quality improvement, documentation accuracy, and clinical compliance. The Clinical Quality & Medicare Performance Nurse builds strong relationships with assigned offices, provides on‑site guidance, and ensures practices meet financial, MRA, HEDIS, and quality‑of‑care goals.

MUST HAVE ACTIVE LPN OR RN LICENSE.

Essential Duties & Responsibilities Conduct regular on‑site visits to assigned offices to review Medicare‑related financial and quality performance, identify gaps, and provide clinical guidance. Support physicians and clinical teams in achieving MRA, HEDIS, and quality goals through education, chart reviews, and workflow optimization. Prepare clear, actionable reports that help providers understand their performance and opportunities for improvement. Assist with onboarding and training for newly assigned offices to ensure they understand Medicare Advantage requirements and documentation standards. Respond to clinical and operational questions from practices via phone and email, coordinating with internal departments and health plan representatives. Draft communications, update directories, and collaborate with health plans to ensure accurate information and smooth operations. Submit detailed visit reports and performance feedback to leadership to maintain alignment and transparency. Perform other duties as assigned to support clinical quality and Medicare compliance initiatives. QualificationsRequired Active LPN or RN license (Florida). Ability to perform all essential duties listed above. Strong interpersonal and communication skills. Ability to build trust and rapport with physicians and clinical staff. Education/Experience Associate's degree or equivalent from a two‑year college/technical school, OR 3 months to 1 year of relevant healthcare experience/training, OR A combination of both. Preferred Qualifications 5+ years of experience in Medicare Advantage, Risk Adjustment, or HEDIS quality programs. Experience working directly with Primary Care physicians on quality and financial performance. Knowledge of HEDIS 5‑Star standards and reporting processes. Strong customer‑service mindset and teamwork skills. Communication Skills Ability to read, interpret, and clearly communicate clinical and technical information. Writes professional reports and communicates effectively with physicians, management, and health plan partners. Comfortable presenting information to groups and leadership. Technical Skills Proficient in Excel, Word, Outlook, PowerPoint . Familiar with claims reporting systems such as Accureports . Experience using health plan portals including Availity and Freedom/Optimum . Travel Requirements Regular travel within approximately 100 miles . Occasional overnight travel may be required. Physical Demands Primarily sitting, typing, and phone communication. Occasional lifting up to 10 pounds; rarely up to 25 pounds. Requires close and distance vision. Work Environment Office‑based and field‑based environment. Generally quiet but may vary depending on practice activity.

Job Type:

Full-time Pay:

From $50,000.00 per year

Benefits:

401(k) Dental insurance Health insurance Paid time off Vision insurance

Experience:

HEDIS:

1 year (Preferred) Managed care: 1 year (Preferred) Medical terminology: 1 year (Required)

Leadership:

1 year (Preferred)

License/Certification:

LPN (Preferred) RN License (Preferred) Willingness to travel: 75% (Required)

Work Location:

In person