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) seeks a Quality Navigator to serve as an embedded quality resource within assigned provider practices to improve Medicare Stars, HEDIS, QARR, and value-based care outcomes.

You will partner 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.

Qualifications

• BSN required.
• Current RN licensure in NYS.
• Minimum of 2 years of clinical experience.
• Minimum of 1 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.

Responsibilities

• Support quality improvement efforts to enhance clinical outcomes and care delivery.
• Ensure adherence to preventive care and clinical guidelines.
• Apply HEDIS/QARR/Stars knowledge to guide interventions.
• Identify patients with care gaps using analytics and registries.
• Execute proactive outreach to drive preventive and chronic care adherence.
• Provide clinical support for care gap closure and document in Epic.
• Track outreach outcomes to inform quality improvement.
• Reinforce best practices in communication, education, and follow-up.
• Ensure timely follow-up to improve continuity of care and patient satisfaction.
• Identify drivers of CAHPS performance at the practice level.
• Identify high-risk/high-utilizing patients and support care coordination to reduce ED/IP use.
• Support transitions of care and post-discharge outreach to reduce readmissions.
• Partner with providers and interdisciplinary teams to support care delivery.
• Connect patients to community resources to improve access and outcomes.

Skills

Clinical experience

Ambulatory care

Medicare Advantage

Population health

Quality improvement

Care management

Analytical skills

Patient engagement

Education

BSN

RN licensure NYS

Tools

Epic

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

• Hiring Range: $87,600 - $100,500