RN Quality Navigator: Medicare Stars & Care Optimization

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

Job summary

AdvantageCare Physicians (ACPNY) is seeking a Quality Navigator to serve as an embedded clinical quality resource within provider practices, improving Medicare Stars, HEDIS, QARR, and value-based care outcomes. You will collaborate with providers, leadership, and care teams to close care gaps, enhance chronic disease management, and drive practice-level quality initiatives.

The role requires a BSN and NYS RN licensure, with at least 2 years of clinical experience and 1 year in ambulatory

Qualifications

• BSN required.
• Current RN licensure in NYS.
• Minimum 2 years of clinical experience.
• At least 1 year in an ambulatory setting.
• Experience with Medicare Advantage, Managed Care, Population Health, Quality Improvement or Value-Based Care.
• Experience supporting HEDIS, QARR, Stars, NCQA programs.
• Knowledge of chronic disease management and care coordination.
• Experience with EMR and population health platforms.
• Strong analytical, communication, and patient engagement skills.

Responsibilities

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

HEDIS/Quality metrics

Care coordination

EMR systems

Patient engagement

Education

BSN

RN license NYS

Tools

Epic EMR

Population health platforms

Job description

AdvantageCare Physicians (ACPNY) is seeking a Quality Navigator to serve as an embedded clinical quality resource within provider practices, improving Medicare Stars, HEDIS, QARR, and value-based care outcomes. You will collaborate with providers, leadership, and care teams to close care gaps, enhance chronic disease management, and drive practice-level quality initiatives.

The role requires a BSN and NYS RN licensure, with at least 2 years of clinical experience and 1 year in ambulatory