Senior Manager, Clinical Quality

🕒 vor 16 Tagen

⛰️ Colorado, Florida, +4 weitere Bundesländer – Remote

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

💵 $120.000 - $150.000 / Jahr

⏰ Vollzeit

🟠 Senior

👔 Manager

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Abby Care

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51 - 200 Mitarbeiter

⚕️ Krankenversicherung

👥 B2C

Healthcare Insurance • B2C

Abby Care ist ein Service, der Familien dabei hilft, für die Pflege von Angehörigen mit Behinderungen oder besonderen Bedürfnissen zu Hause bezahlt zu werden. Die Organisation schult und zertifiziert Familienpfleger kostenlos, verwaltet Einstellung und Gehaltsabrechnung, navigiert durch Medicaid- und Versicherungsunterlagen, um Zahlungen zu sichern, und bietet eine speziell entwickelte Plattform, klinische Unterstützung und Gemeinschaftsressourcen an. Abby Care ist in mehreren US-Bundesstaaten tätig und konzentriert sich darauf, qualitativ hochwertige, vergütete Familienpflege durch Partnerschaften mit Versicherern und Medicaid-Programmen zu ermöglichen.

Beschreibung

• 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).

🎯 Anforderungen

• 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.

🏖️ Vorteile

• 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.