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About the Role
As RN Clinical Quality Manager, you will safeguard the accuracy of Quality Assurance data and reporting while advancing VillageCare's overall quality strategy. You'll partner across clinical and business teams to integrate improvement efforts and strengthen provider collaboration.
Responsibilities
- Lead performance improvement work for MLTC or Medicare products; drive HEDIS/Stars gap closure
- Analyze claims and quality reports to identify trends, barriers, and opportunities
- Design and oversee initiatives, including HEDIS roadmaps, supplemental data collection, and chart retrieval
- Serve as day-to-day liaison for CMS external audit requests; maintain audit readiness and controls
- Facilitate cross-functional working sessions and guide staff producing quality analyses
- Review dashboards and open items tied to HEDIS/Stars performance, then prioritizing outreach and follow-ups based on data signals
- Join focused check-ins with Quality teammates and partners across the organization to align on progress, remove blockers, and keep timelines on track
- Coordinate with provider offices on record status, confirm supplemental data pathways, and validate that documentation supports measure intent
- Organize requests, confirm completeness, and keep stakeholders informed with clear, timely updates during audit activity
- Balance independent, detail-heavy review with structured collaboration
- End the day with concise notes on decisions, next steps, and items needing escalation to maintain momentum
Requirements
- BSN; active NYS RN license (CPHQ preferred)
- 3-5 years in quality performance improvement with HEDIS/Stars
- 2 years direct hybrid record review
- Strong metrics orientation
- Campaign management experience
- MS Office proficiency
Skills
- Quality Assurance
- Data Analysis
- HEDIS/Stars gap closure
- Claims analysis
- Quality reporting
- CMS external audit requests
- Cross-functional collaboration
- MS Office proficiency
Location
- NY
- NJ
- CT
Work Type
- Hybrid
- Full-time
Experience Level
- 3-5 years
- 2 years
Education Level
- BSN
- NYS RN license
- CPHQ preferred
Salary/Compensations
- $102,549.17 - $115,367.82
About the Company
- VillageCare is a community-based, not-for-profit organization serving people with chronic care needs, as well as seniors and individuals in need of continuing care and managed care services.
- Our mission is to promote healing, better health and well-being to the fullest extent possible.
- Our care is offered through a comprehensive array of community and residential programs, as well as managed care.
- VillageCare has delivered quality health care services to individuals residing within New York City for over 45 years.