Senior Quality Assurance Nurse Manager
Gravie
•$109,000 - $150,000
About The Position
The Senior Quality Assurance Nurse Manager plays a critical role in ensuring Gravie’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).
Requirements
- Active, unrestricted Registered Nurse (RN) license
- 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
Nice To Haves
- Bachelor’s degree in Nursing (BSN) or related field, preferred
Responsibilities
- 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
Benefits
- alternative medicine coverage
- flexible PTO
- up to 16 weeks paid parental leave
- paid holidays
- a 401k program
- transportation perks
- education reimbursement
- 2 days of paid paw-ternity leave
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What This Job Offers
Job Type
Full-time
Career Level
Senior
