Overview
Serves as the subject matter expert for provider quality performance improvement initiatives across Medicare Advantage and other value-based care programs. Partners directly with provider practices and internal stakeholders to drive measurable improvements in quality outcomes, provider performance, and member experience. Serves as a strategic advisor to provider organizations and internal leadership on Medicare Advantage quality performance, provider transformation, and value-based care optimization initiatives. Leads practice transformation strategies focused on HEDIS, CMS Star Ratings, preventive care, chronic condition management, and population health outcomes. Partners closely with Provider Relations representatives to coordinate provider engagement activities, align provider messaging, establish clear role accountability, and ensure consistent communication of organizational quality priorities while serving as the designated quality subject matter expert. Collaborates with provider organizations, clinical leadership, care management, analytics, and operational teams to identify opportunities for performance improvement and implement sustainable strategies that improve member outcomes, provider experience, and health plan quality metrics. Accountable for influencing provider performance outcomes through data-driven consultation, workflow redesign, provider engagement strategies, and implementation of sustainable quality improvement initiatives. Functions as a consultative quality improvement expert and trusted advisor to provider partners participating in value-based arrangements. Directly supports organizational performance related to CMS Star Ratings, HEDIS performance, quality incentive programs, and enterprise population health objectives. Works under general direction.
What We Provide
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 Referral bonus opportunities
What You Will Do
- Develops and maintains strategic relationships with physician executives, practice administrators, provider leadership teams, and health system stakeholders to advance quality performance objectives.
- Serves as the primary advisor and strategic consultant for assigned provider partners, influencing executive leadership, physicians, and operational stakeholders on quality performance improvement, practice transformation, and value-based care success strategies.
- Conducts regular onsite and virtual provider engagement activities, including practice assessments, provider consultations, workflow reviews, and performance improvement meetings.
- Guides provider offices in implementing evidence-based best practices to improve overall Medicare Stars including HEDIS, CAHPS, HOS, medication adherence, patient experience, access to care, care coordination, and other quality performance measures.
- Drives provider engagement strategies and targeted interventions to improve Medicare Star Ratings, HEDIS performance, medication adherence, preventive screening compliance, member experience outcomes, and population health performance measures
- Supports provider adoption of value-based care models, population health strategies, and quality improvement frameworks.
- Utilizes consultative influencing strategies to drive provider engagement, operational change, workflow redesign, and adoption of evidence-based quality improvement practices.
- Promotes provider accountability through regular performance reviews, action planning, follow-up activities, and alignment of performance improvement opportunities with provider incentive programs and value-based contract objectives.
- Analyzes provider performance data, identify trends, forecast performance risks, and prioritize interventions to improve quality outcomes and achievement of organizational quality goals.
- Collaborates with analytics and reporting teams to monitor provider scorecards, gap closure activities, utilization patterns, and quality metrics.
- Partners with provider organizations to improve member experience outcomes through initiatives focused on patient communication, access to care, care coordination, customer service, and CAHPS performance improvement.
- Develops provider-specific action plans and monitor progress toward established performance goals.
- Serves as the quality subject matter expert while Provider Relations maintains responsibility for overall provider account management and relationship oversight.
- Monitors provider performance against established quality benchmarks and lead corrective action planning, performance remediation strategies, and ongoing provider optimization efforts.
- Partners with providers to improve preventive care compliance, chronic disease management, medication adherence, and care coordination outcomes.
- Identifies barriers impacting provider performance and escalate operational or system-related concerns as appropriate.
- Identifies disparities in care, high-risk populations, and quality performance variation and develop targeted interventions that improve equitable access, culturally responsive care delivery, and health outcomes across diverse populations.
- Partners with internal and external stakeholders to align provider quality initiatives with value-based care strategies, provider incentive models, and population health priorities.
- Assists with regulatory readiness activities related to CMS, NCQA, and state quality requirements.
- Maintains accurate documentation of provider interactions, action plans, and intervention outcomes.
- Develops and delivers provider and office staff education programs, training materials, communication strategies, and quality improvement tools focused on quality performance, documentation excellence, and value-based care success.
- Participates in provider meetings, committees, workgroups, and external stakeholder engagements.
- Participates in special projects and performs other duties as assigned.
Qualifications
Education:
- Bachelor's Degree Nursing, Social Work, Healthcare Administration, Public Health, or related field required
- Master's Degree MPH, LMSW/LCSW, MHA, MBA, MSN, or related healthcare discipline preferred
Work Experience:
- Minimum of 8 years of progressive experience in healthcare quality improvement, provider engagement, practice transformation, population health, managed care, or value-based care, including experience leading complex provider performance improvement initiatives required
- Experience working with Medicare Advantage quality programs, HEDIS, CMS Star Ratings, and provider performance improvement initiatives required
- Demonstrated director-level capability in strategic planning, provider relationship management, cross-functional leadership, and execution of enterprise quality initiatives required
- Experience partnering directly with physician practices, provider organizations, executive clinical leadership, or health systems required
- Experience in managed care, health plan operations, ACOs, IPA environments, or value-based payment programs strongly required
- Excellent provider relationship management, facilitation, presentation, and communication skills required
- Experience presenting provider performance data and strategic recommendations to executive leadership, physicians, and external provider organizations required
- Experience supporting quality improvement initiatives within delegated, risk-bearing, or value-based provider arrangements. required required
- Strong knowledge of Medicare Advantage quality programs, HEDIS measures, CMS Star Ratings, NCQA standards, and population health strategies required
- Demonstrated ability to analyze and interpret healthcare performance data and translate insights into actionable improvement strategies preferred
- Understanding of value-based care models, provider incentive programs, and healthcare quality improvement methodologies preferred
Pay Range
USD $146,500.00 - USD $183,100.00 /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.
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VNS Health
paid time off, tuition reimbursement
Jun 30, 2026