Senior Quality Assurance Nurse Manager
1 мес. назад
109k–150k USD / yearSeniorRemote
quality assuranceutilization managementcase managementclinical complianceregulatory compliance
Lead and manage clinical quality assurance programs and compliance in health plan operations.
О компании
- We know healthcare. Our company was founded and is still led by industry veterans who have started and grown several market-leading companies in the space.
- We have raised money from top tier investors who share the same long-term vision as we do of building an industry defining company that will endure over the long run. We are well capitalized.
- Our clients love us. Customer satisfaction rates among employees using health plans consistently rank above 80% – nearly 40 points above the industry average.
- Our culture is unique. We tend to be non-hierarchical, merit-driven, opinionated but kind people who thrive working in a high-performance, fast-paced environment. People at care deeply about making a positive impact in the lives of the people we serve.
Обязанности
- The Senior Quality Assurance Nurse Manager plays a critical role in ensuring ’s clinical operations are compliant, efficient, and centered on delivering high-quality care to members. This role supports operational excellence, regulatory readiness, and quality assurance across all clinical programs while preparing the organization for future accreditation (URAC/NCQA) and the strategic development of in-house Utilization Management (UM).
Требования
- Active, unrestricted Registered Nurse (RN) license
- Bachelor’s degree in Nursing (BSN) or related field, preferred
- 7+ years of clinical experience, with at least 3–5 years in quality assurance, compliance, or accreditation within a health plan, managed care, or healthcare operations environment
- 3+ years of leadership experience
- Deep understanding of UM/CM processes, regulatory requirements, and accreditation standards (URAC, NCQA, CMS)
- Strong analytical and problem-solving skills with demonstrated ability to translate data into actionable insights
Условия
- Our unique benefits program is the gravy, i.e., the special sauce that sets our compensation package apart. In addition to standard health and wellness benefits, ’s package includes alternative medicine coverage, flexible PTO, up to 16 weeks paid parental leave, paid holidays, a 401k program, transportation perks, education reimbursement, and 2 days of paid paw-ternity leave.
Другое
- Hi, we’re . Our mission is to create health benefits that actually benefit small and midsize businesses and their employees. Our innovative benefit solutions and services are developed and delivered by a diverse group of unique people. We encourage you to be your authentic self - we like you that way.
- Design, implement, and manage a comprehensive Clinical Quality Program with embedded QA processes across Utilization Management (UM), Case Management (CM), Care Navigation, Pharmacy, Clinical Stop Loss/Underwriting, and Clinical insights within Health Plan Operations
- Partner with Vendor Oversight to ensure quality and compliance standards are upheld across all clinical vendors and partners
- Lead continuous improvement initiatives to enhance the effectiveness and consistency of clinical operations
- Ensure compliance with state and federal regulations, including all relevant CMS, URAC, and NCQA standards
- Maintain and oversee all clinical licensure requirements (nursing and pharmacy)
- Develop and maintain policies and procedures that align with regulatory and accreditation standards
- Prepare the organization for external reviews, audits, and accreditation surveys
- Lead the tracking, trending, and analysis of clinical performance data to identify risks, inform strategy, and support leadership decision-making
- Develop and manage departmental KPIs, performance metrics, and benchmarking to monitor program effectiveness and quality outcomes
- Oversee the tracking and resolution of grievances, incident reports, and adverse events.
- Provide clear, data-driven insights to Clinical Operations Leadership on opportunities for improvement
- Partner with cross-functional leaders to embed QA principles and processes across all clinical departments
- Develop and deliver regular training sessions for clinical and operational staff related to quality standards, compliance, and continuous improvement initiatives
- Serve as a resource and subject matter expert on clinical quality assurance, compliance, and accreditation standards