Senior Manager, Clinical Quality

🕒 Maio 23

⛰️ Colorado, Florida, +4 estados a mais – Remoto

⛰️ Colorado – Remote 🐊 Florida – Remote 🏖️ New Jersey – Remote 🍂 Massachusetts – Remote 🔔 Pennsylvania – Remote 🎸 Tennessee – Remote

💵 $120.000 - $150.000 / ano

⏰ Tempo Integral

🟠 Sênior

👔 Gerente

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Abby Care

SiteLinkedInTodas as Vagas

51 - 200 funcionários

⚕️ Seguro de Saúde

👥 B2C

Healthcare Insurance • B2C

A Abby Care é um serviço que ajuda famílias a serem remuneradas por fornecerem cuidados domiciliares a entes queridos com deficiências ou necessidades especiais. A organização oferece treinamento e certificação gratuita para cuidadores familiares, gerencia contratações e folha de pagamento, orienta em relação à papelada do Medicaid e de seguros para garantir o pagamento, além de proporcionar uma plataforma desenvolvida para esse fim, suporte clínico e recursos comunitários. A Abby Care opera em vários estados dos EUA e se concentra em possibilitar o cuidado familiar de alta qualidade e remunerado, por meio de parcerias com seguradoras e programas Medicaid.

Descrição

• Design, implement, and evaluate Abby Care’s multi-state Clinical Quality Improvement (CQI) and Quality Assurance (QA) programs. • Partner closely with state Directors of Nursing and Clinical Leads to standardize clinical practices across all active and upcoming markets. • Build a deeply rooted organizational culture that prioritizes patient safety, exceptional care, and caregiver compliance. • Serve as the internal subject matter expert on state-specific Medicaid paid family caregiving regulations, Electronic Visit Verification (EVV), and Home Health Agency (HHA) scope of practice. • Maintain and guarantee perpetual audit-readiness for state Departments of Health (DOH), CMS, and commercial payer reviews. • Deliver targeted remediation training and policy updates to clinical leadership when compliance gaps or regional regulatory updates occur. • Oversee corporate charting standards and multi-state clinical audit frameworks. • Establish performance benchmarks for electronic charting, ensuring clinical necessity is robustly documented to protect authorization utilization and minimize compliance risk. • Analyze complex clinical data and Key Performance Indicators (KPIs), including patient readmission rates, extended visit trends, and clinical incident reports, to drive meaningful interventions and workflow improvements. • Oversee the formal escalation, investigation, and reporting of all critical incidents across operations. • Ensure thorough Root Cause Analyses (RCA) are completed for variances and promptly deploy sustainable Corrective Action Plans (CAPs).

🎯 Requisitos

• Bachelor of Science in Nursing (BSN) required; Master’s degree in Nursing (MSN), Healthcare Administration (MHA), or Public Health (MPH) preferred. • Current, active, and unencumbered license as a Registered Nurse (RN). Multi-state/Compact licensure is highly preferred, or a willingness to rapidly obtain licensure in upcoming expansion states. • Minimum of 5 years of licensed clinical nursing experience, with at least 2–3 years in home health care, community health, or managed care environments. • Minimum of 2 years of dedicated, proven experience in clinical quality management, healthcare compliance, or utilization review. • Deep knowledge of OASIS, Home Health Agency (HHA) regulations, and CMS/Medicaid audit processes is highly preferred. • Ability to work flexible hours to match the urgent needs of an evolving startup market, with a willingness to travel locally/regionally as required for state audits and clinical evaluations.

🏖️ Benefícios

• Competitive compensation packages that reflect the value you bring. We reward our team for the impact of their work – full-time employees are eligible for an annual company performance bonus. • Comprehensive health coverage that works for you. Choose from high-quality medical dental and vision options, including a $0 deductible PPO and a company-funded HSA, alongside employer-paid life and disability insurance. • Generous paid time off. We provide policies that allow you to recharge along with 10 paid company holidays. • Financial savings benefits to support your future. We support your financial well-being with HSA contributions, optional FSA and commuter benefits, and full coverage of all 401(k) account fees (employer match not currently offered). • Paid parental leave to support your growing family. We provide paid leave, so you can focus on bonding and adjusting to life as your family grows.