Quality Assurance Nurse

5 days ago


Sacramento, California, United States Hill Physicians Medical Group Full time
About the Role

We are seeking an experienced Quality Assurance Nurse to join our team at Hill Physicians Medical Group. As a key member of our Quality Management and Health Resource Management departments, you will play a critical role in ensuring compliance with regulatory requirements and maintaining the highest standards of patient care.

Your primary responsibilities will include directing preparation for health plan audits, representing our organization at these audits, and acting as the liaison for all UM and QM regulatory and compliance issues. You will also establish QM and HRM standards compatible with health plans, NCQA, state, and federal regulatory requirements, and health plan delegation changes.

Additionally, you will work closely with our HRM analysts to ensure updated letters are generated by the Authorization system, troubleshoot and recommend improvements to system issues related to Tapestry, FaxCom, and other authorization-related systems, and participate in the testing of system changes, upgrades, service packs, etc. as needed.

We offer a competitive salary range of $85,000 - $118,000 per year, depending on experience, and a comprehensive benefits package.



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