Senior Quality Assurance Nurse Manager

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Gravie

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2013

🏥 Healthcare

🛡️ Insurance

🤝 B2B

💰 $150M Private Equity Round - Gravie on 2025-05

Healthcare • Insurance • B2B

Gravie is a benefits and health insurance solutions company that helps small and midsize employers, brokers, and employees access and administer more flexible, affordable health benefits. Its flagship offerings include Comfort (a level-funded health plan), Gravie ICHRA (Individual Coverage Health Reimbursement Arrangement administration), Gravie Pay (support for healthcare costs), and Gravie Care; the company focuses on enabling SMBs to offer individualized, lower-cost coverage and simplifying benefits administration.

📋 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 • 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

🎯 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 • 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.

🏖️ Benefits

• 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