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Senior Registered Nurse
2 months ago
Mass General Brigham is seeking a highly skilled Registered Nurse to fill the role of Senior Registered Nurse - Quality Assurance Specialist. This position 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.
- 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.
- Registered Nurse with 5-10 years of clinical experience in a healthcare setting.
- 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.
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.
