Quality Rater Jobs in New York (NOW HIRING)

Join a high-performing, mission-driven organization at the forefront of value-based care and quality performance. As Director of Quality and Provider Engagement, you will have a direct seat at the table for both strategy and operations, shaping the future of care for more than 350,000 lives.

Role Overview:

• The Director of Quality and Provider Engagement will collaborate closely with clinical and operational leadership to define strategy, identify and track key performance measures, and drive execution. You will oversee initiatives to increase member engagement, retention, and quality outcomes while delivering measurable financial results through value-based care. This is a senior, cross-functional role that blends lifecycle strategy, audience segmentation, and rigorous experimentation to continuously improve the member and provider experience. The position is intentionally balanced: approximately 50% hands-on operational involvement and 50% people leadership, including coaching and developing a high-performing team. The Director of Quality and Provider Engagement reports directly to the Chief Medical Officer.

Why this role is unique?

• Join one of the best-performing IPAs and ACOs in the region in quality and value-based care performance, recognized by both payers and provider groups as best in class.
• Work alongside top professionals in value-based payment who are passionate about innovation, impact, and equity in care delivery.
• Help drive performance for a panel of over 350,000 lives, with the ability to see your strategies translate into tangible clinical and financial outcomes.
• Be part of a mid-size, nimble organization where decisions are made quickly, bureaucracy is limited, and your voice meaningfully shapes direction.
• Sit at the same table as executive leadership for strategy and operations and collaborate daily with mission-driven talent across clinical, analytics, IT, and provider engagement.

Responsibilities:

• Lead and mentor two high-talent, highly engaged departments: Quality and Provider Engagement, ensuring tight alignment with the company’s vision for health care quality and value.
• Develop and execute strategic plans to improve performance in CMS Star Ratings, HEDIS, Quality Rating System metrics, and other value-based programs (ACOs and payer-specific initiatives relating to quality).
• Provide leadership for strategic plan implementation, translating high-level goals into clear roadmaps, accountability structures, and measurable outcomes.
• Drive regular interdisciplinary meetings to ensure quality initiatives are executed effectively, on time, and with clear ownership and follow-through.
• Serve as operational leader and thought partner on quality, including strategy, process design, implementation, and continuous improvement
• Lead efforts to move the IPA to consistent 4–5 Star performance across key lines of business.
• Represent Quality in internal and external meetings, clearly communicating performance, key initiatives, and outcomes to leadership, payers, and providers.
• Build and deepen business relationships with providers participating in quality and value partnerships; proactively problem-solve and address provider concerns.
• Partner with internal stakeholders to design and deliver provider education and training focused on quality improvement, documentation, and risk adjustment.
• Collaborate with Information Technology to design and continuously enhance the Point-of-Care tools, incorporating feedback from providers, internal teams, and external stakeholders.
• Lead digital transformation for the quality function by reducing manual reporting and championing technology-enabled workflows, analytics, and automation.
• Partner with IT, Data, and Accounting to manage the distribution of quality incentives, risk adjustment earnings, and shared savings.
• Own the strategy and execution of programs aimed at increasing member quality, engagement, and retention across the network.

• Bachelor’s degree in Healthcare, Health Administration, Public Health, or a related field required; Master’s degree preferred.
• 10+ years of experience in health plans, IPAs, ACOs, or similar environments with direct exposure and responsibilities to HEDIS, Star Ratings and provider quality performance.
• Demonstrated success leading teams and initiatives that improved quality and provider engagement in a value-based care environment.
• Strong leadership presence with the ability to interface confidently with senior executives, physicians, and external partners.
• Proven track record of developing and mentoring high-performing teams and fostering a culture of accountability, collaboration, and continuous improvement.
• Excellent communication skills—comfortable presenting to boards, executives, payers, and provider groups, and translating complex data into clear, actionable narratives.
• Strong analytical and critical thinking skills, with the ability to use data to prioritize, problem-solve, and drive decision-making.
• Deep knowledge of CMS Quality Ratings, Star Ratings, NCQA measures and methodologies. .
• Experience designing and delivering provider education programs tied to quality and documentation performance.
• Impeccable discretion and commitment to confidentiality.

Benefits and Compensation:

• Competitive base salary in the range of 120,000–150,000, commensurate with experience and impact.
• Comprehensive health benefits, including medical, vision, and dental coverage.
• Company-paid life insurance.
• 401(k) retirement plan with a 6% corporate match.
• Generous Paid Time Off and 13 paid holidays.
• Hybrid work schedule that supports both collaboration and focused work time.

This role is well-suited for a top performer who has already proven their impact within a larger or more bureaucratic organization and now wants to step into a leadership position where they can move faster, have greater visibility, and directly shape both strategy and execution in a mission-driven, mid-size company.