Senior Quality Assurance Nurse Manager

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October 24

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Gravie

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Healthcare Insurance • Fintech • B2B

Gravie is a company specializing in providing innovative health benefits and insurance solutions. Their offerings include the Comfort health plan, which simplifies health coverage with no deductibles and zero copays on common healthcare services. Gravie also provides Individual Coverage Health Reimbursement Arrangements (ICHRA) and Gravie Pay, a support system for managing healthcare costs. The company emphasizes clear and straightforward benefits that facilitate preventive care and reduce unexpected healthcare expenses, catering to both individual members and small to midsize businesses. Gravie aims to make health benefits accessible, understandable, and cost-effective for employers and employees alike.

51 - 200 employees

⚕️ Healthcare Insurance

💳 Fintech

🤝 B2B

📋 Description

• 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. • 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.

🎯 Requirements

• 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. • 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.

🏖️ Benefits

• alternative medicine coverage • flexible PTO • up to 16 weeks paid parental leave • paid holidays • 401k program • cell phone reimbursement • transportation perks • education reimbursement • 1 week of paid paw-ternity leave