Quality Assurance Manager – Clinical Systems

🔥 13 hours ago

🌲 Oregon – Remote

🌲 Oregon – Remote

💵 $140.9k - $172.3k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔧 QA Engineer (Quality Assurance)

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CareOregon

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1994

🏥 Healthcare

📦 Logistics

🛡️ Insurance

Healthcare • Logistics • Insurance

CareOregon is a community-focused health plan that provides coordinated physical, behavioral, dental and social-support services to Oregon Health Plan members, serving more than 500,000 people. The organization operates provider and member portals, offers care coordination, telehealth, language and tribal services, community grants and outreach, and programs addressing social determinants of health such as housing, nutrition and transportation.

📋 Description

• Provide leadership oversight in the correct and effective use of decision tools for utilization management activities, including staff training • Manage multiple teams and resources • Collaborate with Clinical Operations and other CareOregon teams to integrate and support organizational activities and goals across all lines of business • Lead department planning and manage internal operations and vendor transactional quality assurance processes • Develop and manage quality assurance reports, dashboards, workflows, testing programs, clinical content, documentation, and verification tools • Ensure clinical systems align with regulatory, contractual, and organizational requirements for Medicare and Medicaid • Analyze data to identify improvement opportunities and recommend process enhancements • Implement strategies for compliance with internal and external plans of correction • Maintain compliance records and monitor regulatory expectations and health plan quality-operation standards • Apply quality improvement and change management methodologies, including root cause analysis and Plan/Do/Study/Act • Prepare internal business reviews and presentations • Serve as a clinical resource for internal and external customers and train staff on clinical content • Collaborate with Medical Directors and Clinical Operations leadership on organizational criteria • Develop project plans, monitor tasks, and ensure on-time delivery of clinical content • Participate in internal and external workgroups, meetings, and audits • Engage stakeholders in performance improvement processes and coordinate with other Quality Assurance leaders • Recruit, hire, supervise, train, coach, motivate, and evaluate employees • Set team direction, staffing plans, goals, expectations, and performance standards • Perform supervisory tasks with Human Resources and support employee development • Work in alignment with CareOregon’s mission, vision, values, equity, diversity, inclusion, policies, procedures, and compliance requirements

🎯 Requirements

• Current unrestricted Registered Nurse (RN) license for State of Oregon • Minimum 5 years’ experience in health plan quality operations, such as member rights, quality assurance, and/or utilization management • Minimum 2 years’ experience in a supervisory position, or minimum 1 year of supervisory experience with completion of CareOregon’s Aspiring Leaders Program (preferred) • Proficiency with nationally accepted clinical guidelines, such as InterQual or MCG (preferred) • Experience developing quality and testing programs, processes and procedures from the ground up (preferred) • Experience with applications and front and back-end system testing and technologies in multiple operating systems and environments (preferred) • Experience in clinical content creation or medical writing (preferred) • Experience with training and onboarding (preferred) • Experience directing vendor testing (preferred) • Strong knowledge of health plan operations • Knowledge of health plan regulatory requirements of Medicaid and Medicare managed care • Knowledge of utilization management principles • Knowledge of managed care concepts and principles • Knowledge of organizational improvement principles and practices • Knowledge of principles of organizational change and ability to act as a change agent • Knowledge of quality improvement concepts, principles and practices • Basic understanding of software development phases • Comprehensive skills in program development, management and evaluation • Strong project management, statistical, analytical, problem-solving, prioritization, and organizational skills • Ability to create test requirements and determine root problems • Ability to work independently and as part of a team, manage multiple projects, meet deadlines, and work under pressure • Excellent written, verbal, spoken, presentation, interpersonal, and leadership skills • Skill in negotiation, conflict resolution, collaboration, and consensus building • Ability to coach, mentor, and inspire staff working onsite and remotely • Ability to lead and influence change and results • Ability to work effectively with diverse individuals and groups • Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day • Ability to hear and speak clearly for at least 3-6 hours/day

🏖️ Benefits

• Bonus opportunity; SIP target of 5% annually • Medical, dental, vision, life, AD&D, and disability insurance • Health savings account • Flexible spending account(s) • Lifestyle spending account • Employee assistance program • Wellness program • Discounts and multiple supplemental benefits, including voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, and 529 College Savings • Retirement plan with employer contributions • Paid time off (PTO) • Paid State Sick Time • Paid holidays • Volunteer time • Jury duty leave • Bereavement leave • Remote work from home • 401(k) contributions for non-benefits-eligible employees