28 Results for

Hedis Review Nurse Jobs in New York

Jobs

New York, NY8 days ago

$85,000–$106,300

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. Collaborates across departments—including Care Management, Utilization Management, Provider Relations, Compliance, and Analytics—to sustain continuous improvement, advance health equity, and ensure regulatory readiness.

Brooklyn, NY8 days ago

$109,900–$146,500

Manages and provides comprehensive, advanced nursing care, including post-discharge aftercare visits, annual comprehensive assessment visits, palliative care-care management program onboarding, and change in condition assessment visits (including physical examination, comprehensive history, screening for physical and/or psychological conditions, and point of care testing). Provides care in one or more care settings based on the clinical requirements: virtually, telephonically or travels to patients’ homes and/or other facilities with varying environments (e.g., elevated buildings, walk-ups, care facilities, single/multiple family homes, presence of pets, etc.) using approved transportation options.

New York, New York30+ days ago

Remote

$93,400–$116,800 Per Year

Ensures Quality Improvement programs are aligned with CMS Triple Aim framework: improving the patient’s experience of care (including quality and satisfaction), improving the health of populations, and reducing the per capita cost of healthcare. This is an opportunity to apply your clinical expertise beyond bedside care, leveraging your knowledge to influence system-wide improvements, enhance compliance, and protect member safety at scale, while benefiting from the flexibility of a hybrid role.

Niagara Falls, NY30+ days ago

$120,000–$130,000 Per Year

We are seeking a dedicated Nurse Practitioner or Physician Assistant to provide comprehensive, longitudinal primary care services to patients in their homes and community-based settings, including assisted living facilities, skilled nursing facilities, and group homes. By providing your phone number, you consent to: (1) receive automated text messages and calls from the Judge Group, Inc. and its affiliates (collectively "Judge") to such phone number regarding job opportunities, your job application, and for other related purposes.

Watertown, NY11 days ago

$109,500–$164,000 Per Year

The fraudulent LinkedIn messages and emails, which do not originate from any Executives LinkedIn account or of UnitedHealth Group's email domains, or those of any of its operating divisions, supposedly conducts an interview via a Zoom meeting, offers a work from home job at Optum, emails an application, sends a fake check by next day delivery through USPS and asks recipients to pay a vendor a large dollar amount. Requisition number: 2350468 Job category: Healthcare Delivery Primary location: Watertown, NY Additional locations: Syracuse, New York | Oswego, New York | Fulton, New York | Liverpool, New York Date posted: 05/21/2026 Overtime status: Exempt Travel: No.

Melville, New York30+ days ago

$42–$65 Per Hour

Triage all patients for basic vital signs, chief complaints and purpose of visit and reviews charts for recent visits, chronic problems, recent and outstanding laboratory studies, and other information that would facilitate prompt and complete care. The Registered Nurse Provides general nursing care to patients in the physician’s office by performing their duties to the full level of their licensure in accordance with NYS guidelines as outlined below.

Manhattan, NY30+ days ago

$58–$60 Per Hour

A respected healthcare organization in Midtown Manhattan is seeking an experienced Wellness QA Nurse Manager (RN) to lead quality improvement initiatives, support provider collaboration, and drive better patient outcomes across diverse populations. This is an excellent opportunity for a strong clinical leader who understands HEDIS, quality metrics, population health, and team mentorship —while remaining hands-on in improving care delivery.

New Hyde Park, NY12 days ago

$93,900–$117,400 Per Year

Our primary, multispecialty, and urgent care providers serve millions of patients in traditional practices, patients' homes and virtually through VillageMD and our operating companies Village Medical, Village Medical at Home, Summit Health, CityMD, and Starling Physicians. We are innovating value-based care and leveraging integrated applications, population insights and staffing expertise to ensure all patients have access to high-quality, connected care services that provide better outcomes at a reduced total cost of care.

Troy, New York30+ days ago

$2,400–$10,000 Per Year

Ability to practice autonomously in a remote clinical environment, including independently conducting patient assessments, formulating evidence-based treatment plans, managing complex chronic conditions, and making sound clinical decisions without direct on-site supervision. Pay Range: $2,400.00 - $10,000.00 per month (Potential income) Earnings will vary based on completed assessments, state of residence, and business needs as there is no guarantee of visits or minimum income.

Bethpage, NY21 days ago

Performs duties involving direct patient care as assigned by the physician within the framework of the New York State Nurse Practice Act and AdvantageCare Physicians' policies and procedures. Takes complete and accurate messages from individuals contacting the medical facility by telephone, including messages related to patient needs intended for providers and clinical staff.

Bronx, New York30+ days ago

$145,000–$175,000 Per Year

Provide leadership and direction for care management teams, including nurses, social workers, and care coordinators, to ensure effective care coordination for high-risk, high-cost patient populations. Overview: Essen Health Care is the largest privately held, multispecialty medical group in New York, providing high-quality, compassionate care to some of the state’s most vulnerable and underserved residents.

New York City, NY30+ days ago

$260,000–$340,000 Per Year

Monogram Health employs a robust clinical team, leveraging specialists across multiple disciplines including nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care to diagnose and treat health issues; review and prescribe medication; provide guidance, education, and counselling on a patient's healthcare options; as well as assist with daily needs such as access to food, eating healthy, transportation, financial assistance, and more. Reporting to the Region President, the Market Physician Executive (MPE) is a key clinical leader within Monogram Health who contributes to the development and oversight of clinical strategies, policies, programs, processes, protocols, guidelines, and operations that drive improved patient health outcomes within the market.

New!

New York City, NY1 day ago

$260,000–$340,000 Per Year
Part-time

Monogram Health employs a robust clinical team, leveraging specialists across multiple disciplines including nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care to diagnose and treat health issues; review and prescribe medication; provide guidance, education, and counselling on a patient’s healthcare options; as well as assist with daily needs such as access to food, eating healthy, transportation, financial assistance, and more. Reporting to the Region President, the Market Physician Executive (MPE) is a key clinical leader within Monogram Health who contributes to the development and oversight of clinical strategies, policies, programs, processes, protocols, guidelines, and operations that drive improved patient health outcomes within the market.

New York, NY30+ days ago

$39,960–$70,200 Per Year

Work closely with Clinical Pharmacist(s), Registered Nurses and Data Analyst(s) to prioritize members for outreach who fall in HEDIS measures including but not limited to Medication Adherence and OMW (Osteoporosis Management in Women who had a fracture) and the STAR measure MTM (Medication Therapy Management) Program. Perform provider and member outreach to reconcile member records and validate data entry to support continuous quality improvement in Healthcare Effectiveness Data and Information Set (HEDIS) rates and STAR measures for the enterprise.

New York, NY30+ days ago

$85,000–$106,300 Per Year

Licenses and Certifications: License and current registration to practice as a Registered Professional Nurse in New York State or New Jersey required Education: Bachelor's Degree Nursing 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, 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). 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.

New York, NY30+ days ago

$93,400–$116,800 Per Year

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. Powered and informed by data analytics that are unmatched in the home and community-health industry, VNS Health offers a full range of health care services, solutions and health plans designed to simplify the health care experience and meet the diverse and complex needs of the communities and people we serve in New York and beyond.

Syracuse, NY8 days ago

$58,000–$100,000 Per Year

Act as a clinical subject matter expert supporting initiatives such as Transitions of Care (TOC), pre-visit planning, Care Management, Annual Wellness Visits (AWV)/preventative care completion and Voluntary Alignment (or other contract-driven growth initiatives). The Practice Facilitator (RN/LPN) is a registered nurse OR licensed practical nurse who supports primary care practices participating in value-based payment programs by guiding, coaching, and enabling practice transformation efforts.

New York, NY30+ days ago

$155,000–$170,000 Per Year

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. Under the supervision of the Senior Director of Integrated Care Management (ICM), the Director of ICM (Medicare) provides clinical and administrative oversight for the Medicare Advantage and Integrated Benefits for Dually Eligible ("IB-Dual") populations, also known as the Medicare dual eligible special needs plan (D-SNP) line of business.

New!

Buffalo, NY1 day ago

Must possess strong leadership skills, excellent written and verbal communication skills, project management and organizational skills, problem solving and analytical skills, ability to make decisions using solid judgment skills to impact identified problems, and the ability to work effectively with all levels of staff in the health care industry. Performs ongoing program evaluation for effectiveness and value, and is responsible for providing ongoing input to department, division and corporate leadership as to the effectiveness of the MCM programs as well as identification of opportunity for enhancements to those programs for the benefit of our members and our company.

New York, New York30 days ago

Remote

$75–$105 Per Hour

This role supports current and upcoming remote consulting opportunities focused on structured healthcare compliance review, care coordination workflow analysis, care plan documentation, quality measure assessment, value-based care support, and high-quality project execution. Selected professionals will apply their healthcare expertise to review realistic compliance and care coordination scenarios, evaluate documentation requirements, prepare structured written outputs, and support accurate, evidence-based healthcare workflow tasks.

New York, NY30+ days ago

$40,200–$54,570 Per Year

Conduct supervised outreach with a Clinical Eligibility Nurse or Care Manager (phone and in-person/home visits) to Medicare and Medicaid members for care management engagement, appointment reminders, preventive screenings, post-discharge follow-up, and resource navigation. Interns do impactful work, collaborating with other interns, employees, and business leaders to solve current operational and clinical workflow challenges, strengthen member experience, and deliver measurable solutions aligned to quality and service goals.

New York, NY30+ days ago

About NYC Health Hospitals MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens, and Staten Island through a comprehensive list of products, including but not limited to: • New York State Medicaid Managed Care • Medicare • Child Health Plus • Exchange Partnership in Care • MetroPlus Gold • Essential Plan. Licensure and/or Certification Required: • A valid license and current registration to practice as a Licensed Mental Health Counselor (LMHC) • Licensed Marriage and Family Therapist (LMFT) • Licensed Master Social Worker (LMSW) • Licensed Clinical Social Worker (LCSW) issued by the New York State Education Department (NYSED) is required.

Whitestone, NY26 days ago

The Medical Pod Leader will be the clinical leader responsible for the clinical performance of clinical pod team members to include: Accurate diagnosis and documentation, quality, patient experience, affordability, patient safety, clinical team dynamics, and provider productivity. Collaborate with clinical team members associated with pod (Community Health Workers, Medical Social Workers, Nurse Navigators, Care Managers, Patient Care Coordinators, etc.).

Whitestone, New York27 days ago

Responsibilities: The Medical Pod Leader will be the clinical leader responsible for the clinical performance of clinical pod team members – to include: Accurate diagnosis and documentation, quality, patient experience, affordability, patient safety, clinical team dynamics, and provider productivity. Collaborate with clinical team members associated with pod (Community Health Workers, Medical Social Workers, Nurse Navigators, Care Managers, Patient Care Coordinators, etc.).

New York, NY8 days ago

$83,000–$86,000 Per Year

Licensure and/or Certification Required: A valid license and current registration to practice as a Licensed Mental Health Counselor (LMHC), Licensed Marriage and Family Therapist (LMFT), Licensed Master Social Worker (LMSW), or Licensed Clinical Social Worker (LCSW) issued by the New York State Education Department (NYSED) is required. MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.

New York, NY30+ days ago

$85,000–$95,000 Per Year

Educate providers to alternate treatment services being promoted by Health + Hospitals in lieu of Inpatient Detox Attends and prepares for bi-Weekly Interdisciplinary Care Team (ICT) meetings which will feature newly enrolled, frequently admitted, high utilizing at risk HARP members. The HARP Care Manager develops, facilitates, and communicates a plan of care in partnership with the member, his/her assigned Health Home, primary caregiver, the primary and attending physicians, and various Behavioral Health and/or Substance Use Disorder providers.

New York, NY25 days ago

$82,000–$83,000 Per Year

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics.

New York City, NY30+ days ago

$260,000–$340,000 Per Year

Reporting to the Region President, the Market Physician Executive (MPE) is a key clinical leader within Monogram Health who contributes to the development and oversight of clinical strategies, policies, programs, processes, protocols, guidelines, and operations that drive improved patient health outcomes within the market. Each market is comprised of 5-10 practices led by local advanced practice providers (APP), registered nurses(RN), licensed clinical social workers (LCSW), and pharmacists (PharmD).

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Hedis Review Nurse Jobs in New York

Clinical Quality Improvement Specialist, Registered Nurse (Onsite 4 Days/Week) VNS Health

Advanced Practice Clinician (Bilingual Chinese required) VNS Health

Quality Reviewer/Auditor, Registered Nurse (Remote) VNS Health

Nurse Practitioner Judge Group

Nurse Practitioner or Physician Assistant - Care At Home - Jefferson Oswego Counties UnitedHealth Group Inc

RN Catholic Health

Wellness QA Nurse Manager Wellness Phaxis

Clinical RN Manager Summit Health Inc

Nurse Practitioner (Per Diem) ComplexCare Solutions

Specialty RN - Bethpage AdvantageCare Physicians

Director of Population Health Essen Medical Associates

Market Physician Executive (MPE) Monogram Health Inc

Market Physician Executive (MPE) Monogram Health Professional Services

Quality Outreach Specialist EmblemHealth Inc

Quality Improvement Specialist, Clinical VNS Health

Quality Reviewer/ Auditor VNS Health

Senior Practice Facilitator CINQCARE

Director of Integrated Case Management for Medicare Metroplus Health Plan Inc

Manager, Care Management (Specialty Team) Univera Healthcare

Remote 24-MAG

2026 Summer Internship - Nursing Intern Healthfirst

Health and Recovery Plan Care Manager Metroplus Health Plan Inc

Physician Leader- Westchester/Queens NY HarmonyCares.

Physician Leader Primary Care- Queens/Westchester County NY- $50k Retention Bonus HarmonyCares

Children's Behavioral Health Care Manager Metroplus Health Plan Inc

HARP Care Manager (with up to $10,000 additional field differential) Metroplus Health Plan Inc

Behavioral Health Care Manager Metroplus Health Plan Inc

Market Physician Executive (MPE) Monogram Health

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