Senior Quality Assurance Nurse Manager

🕒 Julho 28

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Gravie

SiteLinkedInTodas as Vagas

201 - 500 funcionários

Fundada em 2013

🏥 Saúde

🛡️ Seguros

🤝 B2B

💰 $150.000.000 Private Equity Round - Gravie em 2025-05

Healthcare • Insurance • B2B

A Gravie é uma empresa de soluções de benefícios e seguros de saúde que ajuda pequenas e médias empresas, corretores e funcionários a acessar e administrar benefícios de saúde mais flexíveis e acessíveis. Seus principais produtos incluem Comfort (um plano de saúde com financiamento em nível definido), Gravie ICHRA (administração de Arranjo de Reembolso de Saúde para Cobertura Individual), Gravie Pay (suporte para custos de saúde) e Gravie Care. A empresa se concentra em capacitar PMEs a oferecer cobertura individualizada e de menor custo, além de simplificar a administração de benefícios.

Descrição

• 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

🎯 Requisitos

• 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.

🏖️ Benefícios

• 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