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Senior Health Virtual RN
2 months ago
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 is responsible for coordinating clinical quality assurance activities, including training and auditing, to ensure compliance with regulatory requirements and accreditation standards.
Key Responsibilities:- Coordinate clinical quality assurance activities, including training and auditing, to ensure compliance with regulatory requirements and accreditation standards.
- Develop and review training materials, and perform auditing of clinical team members to evaluate compliance with clinical processes and regulatory requirements.
- Work closely with the Clinical Quality Assurance & HEDIS Manager to monitor, maintain, and support the clinical department to maintain a high level of quality performance and comply with regulatory requirements and accreditation standards.
- Participate in departmental and organizational project teams and play a critical role in project implementation by soliciting requirements through interviews, workshops, and/or existing systems documentation or procedures.
- 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.
- Experience using MS Office Suite and SharePoint or other document-sharing software.
- Understanding of project management and business practices.
- Excellent planning, coordination, and facilitation skills.
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. 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.
