LHCSA Home Care Registered Nurse Clinical Quality Manager
The RN, Clinical Quality and Value-Based Program Manager is a leadership-level role responsible for overseeing clinical quality initiatives, value-based care programs, regulatory compliance, and clinical education across LHCSA operations. The role is approximately 60% focused on Case Management leadership and oversight and 40% focused on Quality Management, including audits, performance improvement, data analytics, regulatory compliance, and payer quality requirements.
This position provides direct clinical leadership and oversight for the Brooklyn Case Management division (R1) through the Case Management Team Leader, while collaborating with the Queens Case Management division (C1) to provide quality oversight and ensure consistency with organizational standards. The role directly oversees two Nurse Educators responsible for clinical education and HHA/PCA training initiatives, supported by a remote Quality Specialist who assists with data mining, analytics, reporting, and quality metric tracking.
Position Details
- Job Title: RN, Clinical Quality and Value-Based Program
- Department: Quality and Value-Based Program
- Reports To: Executive Director / Chief Compliance Officer
- Specialty: LHCSA
- Salary Range: $110,000 – $130,000 / year
- Hours / Schedule: Monday – Friday, 9:00 AM – 5:00 PM (Hybrid option: work-from-home potentially 1 day on Friday after 6–12 months in the role)
Location & Commute & Office Locations
- Main Office (Brooklyn): Brooklyn, NY 11219
- Satellite Office (Bronx): Bronx, NY 10455
- Satellite Office (Queens - Jamaica): Jamaica, NY 11432
- Satellite Office (Queens - Flushing): Flushing, NY 11354
Travel & On-Site Expectations
- Primary Base: Brooklyn office.
- Queens Travel: Required approximately once every 2 months as needed.
- Bronx Travel: Required approximately twice per year during HHA training class sessions (classes run ~2 weeks; requires attendance 3 times per class session).
Parking & Public Transit
- Parking: Street parking available (limited during peak hours). No designated employee parking lot.
- Public Transit: Short walking distance to the D* and N* subway lines.
Key Responsibilities1. Clinical Quality & Value-Based Program (VBP) Management
- Utilize clinical tools, data, and health informatics to assess patient needs and drive performance improvement.
- Create individualized, comprehensive case management and treatment plans; facilitate execution through direct oversight of Case Managers.
- Review Case Manager documentation in the EMR system to ensure adherence to clinical, medical, and regulatory protocols.
- Monitor quality management processes, incident/event reports, and key quality measures in compliance with regulatory guidelines and company procedures.
- Oversee and troubleshoot complex clinical issues escalated by Case Managers.
- Lead Quality Record Reviews, audits, and data analytics; prepare quarterly and annual Quality or Performance Improvement reports for the Quality Improvement Committee (QIC).
- Collaborate with participating vendors and managed care organizations to implement and track Value-Based Payment (VBP) initiatives.
- Develop clinical education that promotes advancement for Case Managers, Nurse Educators, and HHAs.
2. NHTD & TBI Program Quality Management
- Serve as the subject matter expert on Nursing Home Transition and Diversion (NHTD) & Traumatic Brain Injury (TBI) program requirements.
- Lead quality reviews of all Serious Reportable Incident (SRI) documentation completed by Case Managers prior to submission to Service Coordinators (SC) and Regional Resource Development Coordinators (RRDC).
- Chair the Serious Reportable Incident Committee (SRIC); convene meetings quarterly at minimum, facilitate sessions, and maintain meeting minutes.
- Prepare and submit required quarterly and annual reports to the RRDC and Quality Improvement Committee (QIC).
3. Clinical Education & Training Programs
- Design, create, and revise curriculum, training plans, and materials for NYSDOH-required orientation and annual mandatory caregiver training (HHA & PCA).
- Provide oversight, supervision, and ongoing education to Nurse Educators.
- Lead NYSDOH expansion and re-approval applications for the Home Health Aide Training Program (HHATP) and Personal Care Aide Training Program (PCATP).
- Oversee the planning, execution, and regulatory compliance of all HHATP and PCATP class offerings.
- Prepare and present quarterly and annual Quality Management Oversight Reports required by the NYSDOH to the Quality Improvement Committee (QIC).
Qualifications & Experience Requirements
Required
- Licensure: Current, unrestricted Registered Professional Nurse (RN) license in New York State.
- Case Management Experience: Minimum of 5 years of nursing experience in Case Management/Care Management within a managed care or home care setting (including direct CM experience or supervision of Case Managers).
- Leadership Experience: Minimum of 5 years of progressive leadership/management experience in healthcare.
- Technical Skills: Competence with MS Office, CRM tools (Salesforce preferred), and Data Informatics/EMR/EHR systems.
Preferred
- Education: Master’s degree in Nursing, Healthcare Administration, or a related field.
- Certifications: Certified Case Manager (CCM), Certified Professional in Healthcare Quality (CPHQ), or Board Certified (BC) specialty credential.
- Background: Prior experience in a LHCSA setting, community outreach experience, or experience with MLTC / Quality Management.
Required Core Competencies
- Excellent verbal and written communication skills with strong cultural awareness.
- Strong analytical, problem-solving, and supervisory leadership skills.
- Ability to thrive collaboratively in a fast-paced environment.
Compensation & Benefits
- Salary: $110,000 – $130,000 per year
- Paid Time Off: 2 weeks PTO (3 weeks negotiable depending on experience)
- Sick Leave: 32 hours paid sick leave
- Holidays: 6 Paid Federal Holidays
- Health & Wellness: Medical, Dental, and Vision coverage
- Travel Reimbursement: Mileage reimbursement ($0.725/mile for business use) OR MetroCard reimbursement
- Retirement: No 401(k) offered
Interview Process
- First Round: Remote interview via Zoom
- Second Round: On-site interview
Apply Today and a Recruiter will reach out ASAP with all of the details and to get you set up to interview FAST!
Pay: $110,000.00 - $130,000.00 per year
Benefits:
- Dental insurance
- Health insurance
- Paid time off
- Retirement plan
- Vision insurance
Work Location: In person
