Senior Health Virtual RN
2 weeks ago
Mass General Brigham Health Plan is seeking a highly skilled Registered Nurse (RN) to join our team as a Senior Clinical Quality Assurance Nurse Auditor. This is a remote role with occasional onsite team meetings in Somerville, MA.
Job Summary:The Senior Clinical Quality Assurance Nurse Auditor will be responsible for coordinating clinical quality assurance activities, including the development and review of training materials, auditing, and preparing for NCQA audits. This role will also involve performing audits to evaluate individuals' compliance with clinical processes, NCQA standards, and regulatory requirements.
Key Responsibilities:- Coordinate clinical quality assurance activities, including training development and review, auditing, and NCQA audit preparation.
- Perform audits to evaluate individuals' compliance with clinical processes, NCQA standards, and regulatory requirements.
- Work closely with the Clinical Quality Assurance & HEDIS Manager to monitor, maintain, and support the clinical department's quality performance.
- Collaborate with the NCQA Quality Team and Sr. Director, Quality Assurance & Process Improvement on an as-needed basis.
- Participate in departmental and organizational project teams and contribute to project implementation.
- Assist with the definition, documentation, training, and support for new required accreditation processes.
- Registered Nurse with 5-10 years of clinical experience in a healthcare setting.
- Quality Assurance auditing experience a plus.
- NCQA experience preferred.
- Complex Care Management experience preferred.
- Utilization Management (InterQual) experience preferred.
- Excellent planning, coordination, and facilitation skills.
- Ability to translate and communicate complex topics effectively.
Mass General Brigham Health Plan 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. We are committed to 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, a benefits package with flexible work options, career growth opportunities, and much more.
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Senior Health Virtual RN
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Belmont, Massachusetts, United States Mass General Brigham Full timeJob Title: Senior Clinical Quality Assurance Nurse AuditorMass General Brigham Health Plan is seeking a highly skilled Registered Nurse to join our team as a Senior Clinical Quality Assurance Nurse Auditor. This role is responsible for coordinating clinical quality assurance activities, including training and auditing materials, and performing audits to...
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Senior Health Virtual RN
2 weeks ago
Belmont, Massachusetts, United States Mass General Brigham Full timeJob Title: Senior Clinical Quality Assurance Nurse AuditorMass General Brigham Health Plan is seeking a highly skilled Registered Nurse to join our team as a Senior Clinical Quality Assurance Nurse Auditor. This role is responsible for coordinating clinical quality assurance activities, including training and auditing materials, and performing audits to...
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