Senior Quality Assurance Manager Nurse

Responsibilities

·         Provide strategic and operational leadership to registered nurses and allied clinical staff

·         Oversee daily operations, ensuring efficient workflows and appropriate staffing levels

·         Participate in coordinating and developing Quality Improvement initiatives and monitor performance metrics and outcomes

·         Review generic charts and other population-based data to identify trends, gaps, and opportunities for quality improvement across chronic conditions for provider groups and individual providers, then address them

·         Serve as a clinical liaison between the Fund and Providers on quality-of-care concerns (HEDIS and other Performance Measures)

·         Review performance, evaluate effectiveness, analyze data, identify trends, and collaborate with business leads to recommend enhancements

·         Engage Fund Registered Nurses (RN), Health Educators (HE), and Social Workers (SW) in quality assurance projects, such as outreach to members with gaps in care

·         Assist Medical Director in hiring, recruiting, onboarding and evaluation of clinical staff

·         Provide supervision, mentoring, coaching, and clinical oversight of all Wellness clinical staff to strengthen competencies.

·         Educate members regarding acute and chronic conditions and promote healthier lifestyle behaviors.

·         Participate in seasonal vaccination and other types of testing as needed.

·         Participate in Health Fairs, Screenings, and Outreach Events in New York City and outer borough locations as needed

·         Perform additional duties and projects, as assigned by management

·         Ability to work flexible hours including evenings and weekends as needed

Qualifications

·         A valid New York State Registered Nurse (RN) license is required; Bachelor’s degree required  

·         Minimum of six (6) years of nursing experience in ambulatory care, community health care, or medical/surgical settings, including at least three (3) years in quality improvement and four (4) years in management required

·         Strong experience in clinical assessment, patient education, motivational interviewing, critical thinking, independent decision-making, quality assurance, and quality improvement

·         Excellent nurse-physician communication, leadership, coaching, and team-building skills are required.

·         Knowledge of Healthcare Effectiveness Data and Information Set (HEDIS) and National Committee for Quality Assurance (NCQA)

·         Intermediate computer and digital literacy

·         Basic proficiency in Microsoft Outlook, Word, and Excel is preferred