Senior Quality Improvement Specialist, Clinical (Registered Nurse)

VNS Health; New York (NY); Híbrido; USD 93.000 - 117.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Referral bonus opportunities

30 days PTO + 9 holidays

Health insurance for you and family

Employer-matched retirement savings

Wellness programs

Pre-tax FSAs

Tuition reimbursement

Professional growth opportunities

Internal mobility and advancement

Descripción de la vacante

VNS Health in New York seeks a Quality Improvement Nurse Leader to drive QI initiatives across DOH, CMS, and NCQA standards. You will conduct clinical reviews, support care coordination, and coach teams in PDSA, LEAN, and data-driven improvement with cross-functional partners.

The role emphasizes performance measurement (HEDIS/CAHPS), alignment with regulators, and development of training to sustain quality and regulatory readiness.

Formación

• Licensed Registered Nurse in NY or NJ (current registration).
• Bachelor's Degree in Nursing, Social Work or related Behavioral Health field.
• Minimum 5 years of health plan or health care experience.
• Minimum 4 years of quality improvement experience.
• Minimum 2 years in quality management and compliance.
• Experience leading cross-functional quality initiatives.
• Excellent oral and written communication; group facilitation skills.
• Knowledge of PDSA/LEAN; Six Sigma preferred; data analysis experience.

Responsabilidades

• Conduct clinical assessments including medication reconciliation and post-discharge follow-up.
• Collaborate across departments to ensure DOH/CMS/NCQA compliance and coach teams in continuous improvement.
• Perform medical record audits and support HEDIS/QARR documentation.
• Lead multidisciplinary QI teams to design, implement, and evaluate improvement initiatives.
• Support value-based programs through data review and provider feedback.
• Develop training materials, guidelines, and quality protocols for provider networks.

Conocimientos

Quality improvement

Cross-functional collaboration

Communication

Data analysis

Educación

Bachelor's Degree Nursing or related Behavioral Health field

Herramientas

PDSA

LEAN

Six Sigma

Descripción del empleo

Overview

Supports interdepartmental Quality Improvement (QI) initiatives focused on promoting high-quality, safe, and equitable member care. Serves as a clinical and operational resource to QI committees, workgroups, and leadership. Analyzes outcomes, HEDIS/CAHPS/Stars performance, and trend data to identify opportunities for improvement in care coordination, quality, and member experience. Designs, implements, and evaluates QI programs aligned with DOH, CMS, and NCQA standards. Collaborates across departments—including Care Management, Utilization Management, Provider Relations, Compliance, and Analytics—to sustain continuous improvement, advance health equity, and ensure regulatory readiness.

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life Disability
• Employer-matched retirement saving funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

What You Will Do

• Conducts clinical assessment including and not limited to, medication reconciliations, post-discharge transitions of care assessment and follow-up post emergency department assessment.
• Collaborates across departments to ensure compliance with DOH, CMS, and NCQA requirements. Coaches teams in applying continuous improvement methodologies (PDSA, LEAN, RCA) to achieve strategic objectives and national benchmarks for quality, satisfaction, and cost. Partners with analytics and program teams to identify trends and address performance gaps.
• Performs clinical reviews with network providers to validate diagnoses, address care gaps, and support accurate HEDIS/QARR documentation. Collaborates with providers to improve adherence to evidence-based care and quality measures.
• Participates in multidisciplinary QI teams and committees to support design, implementation, and evaluation of improvement initiatives related to clinical performance, documentation, and regulatory compliance. Supports development of annual QI work plan, program evaluation, and performance reporting.
• Supports value-based programs through data review, gap identification, and provider feedback.
• Performs medical record audits to evaluate adherence to documentation, coding, and quality standards. Provides education, feedback, and guidance to PCPs on VNS Health Medical Record Documentation Standards.
• Conducts audits of patient care records to monitor care quality and documentation accuracy.. Develops forms, record abstracts, reports, and other tools used to implement concurrent and retrospective patient care review, including the design, testing and evaluation of the review methodology.
• Performs utilization and quality assessment reviews to maintain compliance with Federal and State regulatory requirements. Identifies & analyzes results to inform the development of correction plans.
• Collaborates with management to develop measurable action plans based on root-cause analysis, outcome trends, and survey results (HEDIS, CAHPS, Stars). Presents recommendations to QI committees and leadership to drive improvement and accountability.
• Participates in the preparation for and assists with site visits of external providers for the purpose of regulatory quality compliance.
• Develops and disseminates training materials, clinical guidelines, and quality protocols to promote consistent evidence-based care across provider networks and internal teams. Provides education sessions and quality coaching as needed.
• Conducts follow-up reviews and reassessments to ensure corrective actions for regulatory findings, complaints, or incidents are implemented effectively and sustained over time. Documents progress and escalates unresolved issues as appropriate.
• Develops, maintains, and updates QI policies and procedures aligned with evolving regulatory and industry standards. Collaborates with analytics to collect, interpret, and share performance data with internal teams to drive transparency and accountability.
• Participates in special projects and performs other duties as assigned.

Qualifications

Licenses and Certifications:

• License and current registration to practice as a Registered Professional Nurse in New York State or New Jersey required

Education:

• Bachelor's Degree Nursing, Social Work or other Behavioral Health field required

Work Experience:

• Minimum of five years experience in a health plan or health care setting required
• Minimum of four years quality improvement experience required
• Minimum of two year experience, quality management, practice improvement and compliance required
• Demonstrated experience leading or facilitating cross-functional quality initiatives required
• Excellent oral, written and interpersonal communication skills, including group facilitation skills required
• Knowledge of basic Performance Improvement tools and methodologies (e.g., PDSA, LEAN, Six Sigma). preferred
• Experience applying data analysis to clinical and operational improvement strongly desired. preferred

Pay Range

USD $93,400.00 - USD $116,800.00 /Yr.

About Us

VNS Health has been committed to meeting the needs of New Yorkers for over 130 years. We’re one of the largest nonprofit home- and community-based health care organizations in the country, and today, more than 11,500 team members work together to make a difference in the lives of more than 99,000 patients and members on any given day.