Quality Navigator (Registered Nurse) - Upper East Side, Manhattan

EmblemHealth; New York (NY); On-site; USD 88,000 - 101,000; Full time

Job summary

AdvantageCare Physicians (ACPNY) in New York City is seeking a Quality Navigator to serve as an embedded clinical quality resource within provider practices. The role partners with providers, care management teams, and interdisciplinary stakeholders to identify and close care gaps, optimize chronic disease management, and drive practice-level quality improvement initiatives.

The ideal candidate has a BSN and NYS RN licensure with at least 2 years of clinical experience, including ambulatory

Qualifications

• BSN required, current NYS RN licensure.
• Minimum 2 years of clinical experience; at least 1 year in ambulatory settings.
• Experience in Medicare Advantage, Managed Care, Population Health, or Quality Improvement.

Responsibilities

• Support quality improvement initiatives to enhance outcomes and care delivery.
• Identify care gaps using analytics and HEDIS checklists; conduct proactive outreach.
• Assist with CAHPS performance and patient engagement through effective communication.
• Document care gaps and follow up in the EHR (Epic) and coordinate with care teams.
• Collaborate with care teams and community resources to improve access and outcomes.

Skills

Analytical skills

Communication skills

Patient engagement

Education

BSN

RN Licensure NYS

Tools

Epic EMR

Population health platforms

Job description

AdvantageCare Physicians (ACPNY) is a primary and specialty care practice serving half a million patients across the New York metropolitan area. With more than 30 medical offices across New York City's five boroughs and Long Island, ACPNY is continually expanding our practice and enhancing our services for communities throughout New York. As we grow, our employees grow with us.

Summary of Position

• The Quality Navigator serves as an embedded clinical quality resource within assigned provider practices to improve Medicare Stars, HEDIS, QARR, and value-based care performance outcomes. The role partners directly with providers, office leadership, care management teams, and interdisciplinary stakeholders to identify and close care gaps, optimize chronic disease management, improve patient engagement, support care transitions, and drive practice-level quality improvement initiatives. The Quality Navigator utilizes clinical expertise, analytics, and performance data to improve member outcomes, enhance patient experience, and achieve organizational quality goals

Principal Accountabilities

Quality Improvement & HEDIS/QARR/Stars Performance

• Support quality improvement initiatives to enhance clinical outcomes and care delivery.
• Ensure adherence to preventive care and clinical guidelines across assigned measures.
• Apply knowledge of HEDIS, QARR, and Stars specifications to guide interventions.

Data-Driven Outreach & Care Gap Closure

• Identify and prioritize patients with care gaps using analytics, registries, and HEDIS checklists.
• Execute proactive telephonic and digital outreach to drive preventive and chronic care adherence.
• Provide clinical support for care gap closure (e.g., hospital follow-up) and document in Epic.
• Track and analyze outreach outcomes to inform quality improvement efforts.

Patient Experience & CAHPS Performance

• Reinforce best practices in communication, education, and follow-up.
• Ensure timely follow-up to improve continuity of care and patient satisfaction.
• Identify and address drivers of CAHPS performance at the practice level.

Cost of Care & Utilization Management

• Identify high-risk/high-utilizing patients and support care coordination to reduce avoidable ED/IP use.
• Support transitions of care and post-discharge outreach to reduce readmissions.

Care Team Collaboration & Community Health

• Partner with providers and interdisciplinary teams to support care delivery.
• Connect patients to community resources to improve access and outcomes.

Qualifications

Education, Training, Licenses, Certifications

• BSN required
• Current Licensure as an RN in NYS

Relevant Work Experience, Knowledge, Skills, and Abilities

• Minimum of 2 years of clinical experience
• Minimum of one year in an ambulatory setting
• Experience in Medicare Advantage, Managed Care, Population Health, Quality Improvement, Care Management, or Value-Based Care
• Experience supporting HEDIS, QARR, Stars, NCQA, or quality improvement programs.
• Knowledge of chronic disease management and care coordination principles.
• Experience working with EMR systems and population health platforms.
• Strong analytical, communication, and patient engagement skills.

Additional Information

• Requisition ID: 1000003258
• Hiring Range: $87,600 - $100,500