Senior Health Virtual RN

1 week ago

Everett, Massachusetts, United States Mass General Brigham Full time
Job Title: Senior Clinical Quality Assurance Nurse Auditor

Mass 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 will play a critical part in ensuring the highest level of quality performance and compliance with regulatory requirements and accreditation standards.

Key Responsibilities:
  • Coordinate clinical quality assurance activities, including training and auditing materials development and review.
  • Perform audits to evaluate individual compliance with clinical processes, NCQA standards, and regulatory requirements.
  • Work closely with the Clinical Quality Assurance & HEDIS Manager to monitor and maintain clinical department quality performance.
  • Collaborate with the NCQA Quality Team and Sr. Director, Quality Assurance & Process Improvement on accreditation and regulatory requirements.
  • Participate in departmental and organizational project teams, ensuring process integrity and flexibility.
  • Develop and maintain a Quality Assurance (QA) plan, including auditing, analyzing, and strategizing process refinements and program improvements.
Requirements:
  • 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.
About Us:

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 providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.

Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a consciously inclusive environment where diversity is celebrated. 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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