VP, Quality Improvement & Utilization Strategy

Nascentia Health, Inc.; City of Syracuse (NY); On-site; USD 157,427 - 203,581; Full time

Benefits offered by this job

401K with employer match

On-site gym

Tuition reimbursement

HSA

Paid time off

EAP

Employee recognition platform

Job summary

Nascentia Health seeks a Vice President of Quality Improvement & Utilization Management to lead CMS Stars, HEDIS, and regulatory compliance across MLTC, MAP, ISNP, and DSNP products in multiple New York locations. You will design and refresh the Quality Improvement Program and oversee utilization management functions.

The role requires extensive healthcare quality leadership, strategic data analytics, and strong collaboration with clinical and regulatory teams to drive measurable improvements

Qualifications

• Bachelor's degree required in nursing, public health, administration, or related field.
• Minimum of 10 years of progressive healthcare quality and/or utilization management experience.
• Experience with Medicare Stars, HEDIS, CAHPS; NCQA accreditation and CMS audits preferred.
• Strong leadership to recruit, develop, and retain a high-performing quality and UM team.

Responsibilities

• Lead design and refresh of the organization-wide Quality Improvement Program for all plan lines.
• Own CMS Star Ratings strategy for Medicare Advantage and SNP portfolios.
• Oversee HEDIS, CAHPS, HOS data collection, production, and submission processes.
• Collaborate with care management and provider relations to reduce gaps in care.
• Direct annual evaluation of the Quality Improvement Program.

Skills

Leadership

Strategic thinking

Data analysis

Communication

Education

Bachelor's degree in nursing/public health/administration or related field

Master's degree preferred

Tools

Microsoft Office

Quality reporting platforms

Health plan data/analytics tools

Job description

Nascentia Health seeks a Vice President of Quality Improvement & Utilization Management to lead CMS Stars, HEDIS, and regulatory compliance across MLTC, MAP, ISNP, and DSNP products in multiple New York locations. You will design and refresh the Quality Improvement Program and oversee utilization management functions.

The role requires extensive healthcare quality leadership, strategic data analytics, and strong collaboration with clinical and regulatory teams to drive measurable improvements