Quality Improvement Specialist

Overview VNS Health is seeking a Behavioral Health-focused Quality Improvement Specialist to lead initiatives that improve clinical quality, member outcomes, and provider performance across our Behavioral Health network and partnerships. This role is ideal for an experienced Licensed Clinical Social Worker (LCSW) or other licensed Behavioral Health professional with a passion for population health, behavioral health quality measures, provider collaboration, and healthcare transformation. In this role, you will partner closely with vendor partners, providers, clinical teams, analytics, and network leadership to drive improvement in HEDIS/QARR measures, access to care, transitions of care, and overall member experience. You will use data insights, provider education, and quality improvement methodologies to support measurable improvements in behavioral health outcomes and regulatory performance. The ideal candidate brings a strong understanding of Behavioral Health clinical practice, quality improvement, and health plan operations, along with experience engaging providers and implementing evidence‑based interventions. This is an opportunity to influence system‑wide Behavioral Health quality strategy while improving care for vulnerable populations. 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 Conduct clinical assessment including and not limited to medication reconciliations, post‑discharge transitions of care assessment, and follow‑up post emergency department assessment. Collaborate across departments to ensure compliance with DOH, CMS, and NCQA requirements. Coach teams in applying continuous improvement methodologies (PDSA, LEAN, RCA) to achieve strategic objectives and national benchmarks for quality, satisfaction, and cost. Partner with analytics and program teams to identify trends and address performance gaps. Perform clinical reviews with network providers to validate diagnoses, address care gaps, and support accurate HEDIS/QARR documentation. Collaborate with providers to improve adherence to evidence‑based care and quality measures. Lead and participate in multidisciplinary QI teams and committees to design, implement, and evaluate improvement initiatives related to clinical performance, documentation, and regulatory compliance. Support development of annual QI work plan, program evaluation, and performance reporting. Support value‑based programs through data review, gap identification, and provider feedback. Perform medical record audits to evaluate adherence to documentation, coding, and quality standards. Provide education, feedback, and guidance to PCPs on VNS Health Medical Record Documentation Standards. Conduct audits of patient care records to monitor care quality and documentation accuracy. Develop 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. Perform utilization and quality assessment reviews to maintain compliance with federal and state regulatory requirements. Identify and analyze results to inform the development of correction plans. Collaborate with management to develop measurable action plans based on root‑cause analysis, outcome trends, and survey results (HEDIS, CAHPS, Stars). Present recommendations to QI committees and leadership to drive improvement and accountability. Participate in the preparation for and assist with site visits of external providers for the purpose of regulatory quality compliance. Develop and disseminate training materials, clinical guidelines, and quality protocols to promote consistent evidence‑based care across provider networks and internal teams. Provide education sessions and quality coaching as needed. Conduct follow‑up reviews and reassessments to ensure corrective actions for regulatory findings, complaints, or incidents are implemented effectively and sustained over time. Document progress and escalate unresolved issues as appropriate. Develop, maintain, and update QI policies and procedures aligned with evolving regulatory and industry standards. Collaborate with analytics to collect, interpret, and share performance data with internal teams to drive transparency and accountability. Participate in special projects and perform other duties as assigned. Qualifications Licenses and Certifications License and current registration to practice as a Registered Professional Nurse, LCSW, LMFT, LMHC, LPC, or Licensed Psychologist in New York State or New Jersey required. Education Master’s Degree in Behavioral Health (Social Work or other Behavioral Health field) required. Work Experience Minimum of three years experience in a health plan or health care setting required. Minimum of three years quality improvement experience preferred. Minimum of one year experience in quality management, practice improvement, and compliance preferred. Demonstrated experience leading or facilitating cross‑functional quality initiatives preferred. 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. Pay Range USD $85,000.00 - USD $106,300.00 per year. 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. #J-18808-Ljbffr