Jobs at Nascentia Health

Provides on-site RN clinical coordination in a skilled nursing facility, including patient assessment, care planning, telehealth facilitation, provider communication, transition support, utilization review, quality improvement, and member advocacy. Monitors changes in condition, coordinates services and authorizations, analyzes utilization data, educates patients and staff on the ISNP Model of Care, and supports regulatory compliance and prevention of avoidable hospitalizations.

The Director of Development manages annual fundraising campaigns, donor cultivation and stewardship, corporate partnerships, sponsorships, and fundraising events. The role oversees donation solicitation, vendors, volunteers, event operations, donor database maintenance in Bloomerang, gift processing, reporting dashboards, and Foundation board support. It also develops communications and maintains relationships with donors, sponsors, community leaders, clinicians, staff, and business partners while supporting fundraising strategy and operational execution.

Provide individualized career planning, life skills education, barrier assessment, and resource navigation for trainees pursuing direct care roles. Coach participants on workplace readiness, connect them to community supports, maintain confidential documentation and tracking for grant reporting, collaborate with partners, conduct outreach, and support retention strategies to promote training completion and employment.

Perform QA audits of CHHA and LHCSA clinical records (including OASIS and coding), analyze documentation trends, coach clinicians, follow up on deficiencies, support performance improvement projects, maintain regulatory knowledge (Medicare/Medicaid), and collaborate with interdisciplinary teams to improve patient outcomes and compliance.

Lead enterprise quality improvement and utilization management for multiple health plan lines (MLTC, MAP, ISNP, DSNP). Design and execute CMS Stars strategy, HEDIS/CAHPS/QARR reporting, NCQA accreditation, UM policy and oversight, regulatory audit responses, and data-driven improvement initiatives. Manage quality and UM teams, vendor relationships, dashboards, and cross-functional partnerships to improve member outcomes and regulatory compliance.

Provide claims support for Medicaid and Medicare members by resolving authorization, eligibility, and payment issues; communicate with members, providers, TPAs, and internal teams; document adjudication issues; ensure compliance with policies, HIPAA, and quality improvement activities; deliver courteous customer service.

Handle incoming inquiries and referrals, process member enrollments/disenrollments, determine Medicaid/Medicare eligibility, create and update EHRs, communicate with state/local agencies, track member KPIs, generate correspondence, and ensure DOH/CMS compliance while providing customer service and problem resolution.

Lead operational compliance and regulatory oversight across MLTC, MAPD/D-SNP, CHHA, LHCSA, and Article 28 programs. Manage audits, monitoring, corrective action plans, risk assessments, regulatory filings, training, and coordination with CMS, NYSDOH, and other agencies to ensure operational adherence to Medicare/Medicaid and related regulations.