UR/QA Manager - DC

Verida Inc•Washington, DC

3d•Onsite

About The Position

Provides clinical, operational, and quality assurance leadership in the coordination and oversight of healthcare and transportation-related services. Ensures compliance with regulatory, contractual, and organizational standards through utilization review, quality assurance activities, risk management, staff training, and continuous process improvement. Serves as a clinical subject matter expert and liaison to medical facilities, community organizations, and internal teams while promoting high-quality customer service and operational excellence.

Requirements

Registered Nurse (RN) degree required.
Minimum three (3) years of clinical nursing experience with direct patient care experience preferred.
Experience in utilization review, quality assurance, healthcare compliance, or managed care environment preferred.
Knowledge of Medicare, Medicaid, community resources, dialysis, and nursing home placement processes.
Strong understanding of quality assurance principles, regulatory compliance, and process improvement methods.
Demonstrated leadership, organizational, and problem-solving skills.
Excellent written, verbal, interpersonal, and customer service communication skills.
Ability to work effectively within interdisciplinary teams and manage multiple priorities in a fast-paced environment.
Proficiency in Microsoft Office Suite, including Word and Excel.
Ability to maintain confidentiality and handle sensitive information professionally.
Flexible, self-directed, and able to work independently or collaboratively within a team environment.

Nice To Haves

direct patient care experience preferred
Experience in utilization review, quality assurance, healthcare compliance, or managed care environment preferred

Responsibilities

Performs thorough review of assessments, diagnoses, and service requests to determine appropriateness of care and transportation services.
Coordinates service delivery and monitors service-related issues to ensure continuity of care, program compliance, and customer satisfaction.
Identifies risks, implements safety plans, and collaborates with interdisciplinary teams to address clinical and operational concerns.
Serves as a representative to medical facilities and community partners regarding healthcare and transportation services.
Plans, coordinates, and directs quality assurance and utilization review activities to ensure compliance with company policies, contractual requirements, and regulatory standards.
Conducts audits, analyzes quality data, and applies process improvement methods to enhance operational performance.
Maintains knowledge of healthcare regulations, accreditation standards, and quality assurance requirements.
Investigates customer complaints and develops corrective action plans to improve service quality.
Supports accreditation initiatives and organizational compliance programs.
Develops and facilitates training, outreach, and in-service programs for staff, healthcare providers, and community organizations.
Builds and maintains relationships with healthcare facilities, community agencies, and stakeholders.
Provides presentations and educational resources related to healthcare services, quality standards, and transportation coordination.
Keeps leadership informed of significant operational, quality, compliance, and customer service issues.
Supervises and supports staff involved in quality assurance, utilization review, and service coordination activities.
Assists with development and implementation of policies, procedures, and continuous improvement initiatives.
Performs additional duties as assigned.