Senior Registered Nurse

13 hours ago

Somerville, Massachusetts, United States Mass General Brigham Full time
Job Title: Senior Registered Nurse - Quality Assurance Specialist

Mass General Brigham is seeking a highly skilled Registered Nurse to join our team as a Senior Registered Nurse - Quality Assurance Specialist. This role will be responsible for coordinating clinical quality assurance activities, including the development and review of training materials, auditing, and preparing for NCQA audits.

Key Responsibilities:
  • Conduct monthly file audits for all file requirements
  • Participate in and/or lead clinical Inter-rater Reliability Testing (IRR)
  • Proactively communicate and collaborate within the Clinical and Quality Departments to identify key areas of focus and develop a Quality Assurance (QA) plan
  • Develop written summaries of specific key areas of training required for clinical staff based on audit results
  • Monitor staff adherence to designated NCQA UM, NCQA Complex Care Management (CCM), Quality Improvement (QI) and other standards, contractual and regulatory requirements
  • Work with the Clinical Quality Assurance Manager to communicate recommendations for operational changes based on survey findings to Quality and Clinical leadership
  • Participate in training activities for clinical staff to support adherence to NCQA and other regulatory and internal documentation standards/requirements
  • Support business requirements for system and process improvements
Requirements:
  • Registered Nurse with 5-10 years of clinical experience in a health care setting
  • 5-10 years of health care experience with 2 years of health plan/insurance experience
  • Valid unrestricted Massachusetts RN professional license
  • Quality Assurance auditing experience a plus
  • NCQA experience preferred
  • Complex Care Management experience preferred
  • Utilization Management (InterQual) experience preferred
About Us:

Mass General Brigham is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world's leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.

We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more.

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