78 Best rn network Jobs in Syracuse, New York (April 2026)

Senior Practice Facilitator

16 days ago

Syracuse

Job Description About Grace at Home Grace at Home is an innovative health and care company on a mission to eliminate barriers and to improve care in high-need, urban and rural communities. Grace at Home’s purpose is to every day improve the health and well-being of those who need care the most – in their homes and communities. Overview The Practice Facilitator (RN) is a registered nurse who supports primary care practices participating in value-based payment programs by guiding, coaching, and enabling practice transformation efforts. This role partners closely with practice champions and care teams to improve clinical quality, patient-centered care delivery, operational workflows, and total cost of care for defined populations. The Practice Facilitator focuses on implementing evidence-based quality improvement strategies, supporting population health initiatives, and integrating value-based care best practices within clinical workflows. This is a hybrid role that requires frequent travel to primary care practices and community sites to provide hands-on, on-site support and collaboration. Maintaining close follow ups on regularly scheduled virtual meetings with practice representatives will be necessary to build relationships to aide in successful initiative implementation. Core performance outcomes are directly related to the ability to fully execute interventions or workflows within the practice, in 5 key areas: • Membership alignment (ex. Voluntary Alignment for ACO Reach), • Managing the highest risk membership, • Transition of Care/readmission prevention, • Quality Gap Closure Practice Support • Facilitate understanding and implementation of value-based payment programs, including ACOs, HEDIS/STAR measures, and risk adjustment initiatives., • Present payer and performance scorecards to review benchmarks, identify gaps, and develop/execute improvement strategies., • Develop and support practice-specific quality improvement plans using tailored data, tools, and resources., • Facilitate performance-based interventions in collaboration with internal subject matter experts for HEDIS/STAR and risk adjustment benchmarks., • Analyze practice-level data and scorecards to identify trends, gaps, and opportunities for improvement., • Provide education and coaching on clinical documentation, ICD-10/CPT coding accuracy, risk adjustment, and population health management activities (e.g., Transitions of Care, Annual Wellness Visits, high-risk case management)., • Guide care transformation initiatives using structured, evidence-based improvement methodologies such as Plan-Do-Study-Act (PDSA)., • Build and maintain trust-based relationships with practice leaders, clinicians, and care teams., • Collaborate cross-functionally with internal departments and external stakeholders, interdisciplinary care team, Medical Director, Network Account Manager team, Quality leads, etc., • 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), • Conduct direct patient outreach on behalf of supported practices as needed to support care gaps, quality initiatives, and value-based program requirements., • Perform chart abstraction, review, and data validation activities to support HEDIS and STAR measures, ACO and MSSP reporting requirements, risk adjustment initiatives, and internal or external audits., • Develop and maintain project plans, including milestones, timelines, and outcomes, to support practice transformation initiatives., • Manage multiple concurrent practice engagements while prioritizing resources effectively., • Conduct regular check-ins with practices to assess progress, reinforce goals, andidentifyemerging needs., • Coordinatelogisticsfor practice engagement meetings, including scheduling, agenda development, and follow-up., • Maintain current knowledge of healthcare regulations, clinical quality standards, and value-based care models., • Promote a culture of continuous improvement and adoption of best practices across supported practices., • Document workflows, activities, and outcomes in designated systems and portals., • Provide regular updates to leadership on progress, risks, and successes., • Participate in training, meetings, and professional development activities as required., • Travel frequently to healthcare practices to support on-site implementation and coaching. Licensure: Active Registered Nurse (RN) license in good standing is preferred. Equivalent education or experience considered. Education: Bachelor of Science in Nursing (BSN) preferred; associate degree in nursing with relevant experience considered. Experience: • REQUIRED: Experience working in a medical office setting, preferably primary care., • Experience supporting quality improvement initiatives, population health, or value-based care programs., • Training or experience in root cause analysis and development of quality improvement plans., • Experience leading or supporting initiatives within interdisciplinary clinical teams., • Strong communication, coaching, and interpersonal skills to build trust and collaboration with clinical teams., • Proactive professional who can take strategic direction and work with autonomy, creativity, and accountability, moving initiatives from concept to full execution., • Proficiency in Microsoft Office and electronic medical record (EMR) systems., • Knowledge of HEDIS/STAR measures, risk adjustment, and value-based care principles., • Ability to analyze data and translate insights into actionable practice improvements., • Ability and willingness to travel frequently to practices and community sites., • Bilingual candidates strongly preferred. The working environment and physical requirements of the job include: In-office work is performed indoors in a traditional office setting with air conditioning, artificial light, and an open workspace. In this position you will need to communicate with customers, vendors, management, and other co-workers in person and over devices, sometimes with people who are agitated. Regular use of the telephone and e-mail for communication is essential. Sitting for extended periods is common. Must be able to receive ordinary information and to prepare or inspect documents. Lifting of up to 10 lbs. occasionally may be required. Good manual dexterity for the use of common office equipment such as computer terminals, calculator, copiers, and FAX machines. Good reasoning ability is important. Able to understand and utilize management reports, memos, and other documents to conduct business. Equal Opportunity & Reasonable Accommodation Statement Grace at Home is an Equal Opportunity Employer committed to creating an inclusive environment for all employees. We provide equal employment opportunities to all individuals regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected characteristic under applicable law. If you require a reasonable accommodation during the application or employment process, please indicate this in your application or speak with your recruiter during the hiring process. Disclaimer This job description is intended to describe the general nature and level of work being performed. It is not intended to be an exhaustive list of all responsibilities, duties, and skills required. Management reserves the right to modify, add, or remove duties as necessary. Our Benefits Financial Well-being • Competitive Compensation: We offer competitive salaries to attract and retain the best talent., • Comprehensive Medical Plan: We proudly offer a comprehensive medical option with an employer contribution., • Dental & Vision Coverage: Maintain your oral and eye health with our employer-paid dental and vision plans via MetLife., • Employer-Paid Insurance: Life, Short-Term Disability (STD), and Long-Term Disability (LTD) insurance are provided at no cost to you., • Continuing Medical Education (CME) Allowance for APPs: Stay at the forefront of your field with our CME allowance., • Commuter Benefits: Save on your commute with our commuter benefits program., • Mileage Reimbursement: Get reimbursed for work-related travel expenses.

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