Position: RN Clinical Quality Manager
Location: Hybrid (Must Reside in NY/NJ/CT)
Work Schedule: Monday - Friday, 9:00am - 5:00pm
Compensation: $102,549.17 - $115,367.82 Annual Salary
The Role Scope
As RN Clinical Quality Manager, you will safeguard the accuracy of Quality Assurance data and reporting while advancing VillageCareMAX's overall quality strategy. Reporting to the Director for Quality, you'll partner across clinical and business teams to integrate improvement efforts and strengthen provider collaboration.
Key responsibilities include:
- 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
Required qualifications:
- 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, and MS Office proficiency
Apply to help deliver measurable quality outcomes for members.
A Typical Workday
Your day starts by reviewing dashboards and open items tied to HEDIS/Stars performance, then prioritizing outreach and follow-ups based on what the data is signaling. You'll join focused check-ins with Quality teammates and partners across the organization to align on progress, remove blockers, and keep timelines on track.
Later, you may coordinate with provider offices on record status, confirm supplemental data pathways, and validate that documentation supports measure intent. When audit activity is active, you'll organize requests, confirm completeness, and keep stakeholders informed with clear, timely updates.
Throughout the week, you'll balance independent, detail-heavy review with structured collaboration-ending the day with concise notes on decisions, next steps, and items needing escalation to maintain momentum.
