Quality Assurance Nurse Manager

Quality Assurance Nurse Manager Overview

• The Quality Assurance Nurse Manager oversees clinical quality initiatives, ensuring compliance with standards and promoting optimal patient care outcomes.
• Collaborates on developing goals and outcomes using HEDIS specifications for quality improvement and corrective action plans.
• Serves as a clinical liaison between the organization and providers, addressing quality-of-care concerns.
• Provides supervision and oversight for Wellness Registered Nurses and Health Educators in quality assurance projects.
• Educates members on acute and chronic conditions, promoting healthier lifestyle behaviors and preventive care.
• Participates in seasonal vaccination drives, health fairs, screenings, and outreach events as required.
• Analyzes data, identifies trends, and recommends enhancements to improve clinical quality and patient outcomes.
• Monitors gaps in care for chronic conditions, addressing them with providers and provider groups.
• Engages in hybrid work arrangements, balancing in-office and remote responsibilities effectively.

Quality Assurance Nurse Manager Key Responsibilities & Duties

• Coordinate and develop goals and outcomes using HEDIS specifications for quality improvement initiatives.
• Review charts, population-based data, and abstractions required for quality improvement processes.
• Track and trend reported quality-related issues to identify areas for improvement.
• Supervise and provide clinical oversight for Wellness RNs and Health Educators in quality assurance projects.
• Monitor gaps in care for chronic conditions, addressing these with providers and provider groups.
• Educate members on acute and chronic conditions, promoting preventive care and healthier lifestyles.
• Participate in seasonal vaccination drives, health fairs, screenings, and outreach events as needed.
• Analyze clinical data, evaluate effectiveness, and recommend quality enhancements to business leads.
• Collaborate with providers to address quality-of-care concerns and improve performance measures.

Quality Assurance Nurse Manager Job Requirements

• Valid New York State Registered Nurse (RN) license required; Bachelor’s degree in Nursing preferred.
• Minimum three years of Quality Improvement experience and two years of management experience.
• Strong clinical assessment, patient education, and motivational interviewing skills essential.
• Knowledge of HEDIS specifications and National Committee for Quality Assurance (NCQA) standards.
• Intermediate computer literacy and proficiency in Microsoft Outlook, Word, and Excel preferred.
• Bilingual in Spanish preferred; valid NYS driver’s license advantageous for travel requirements.
• Ability to work flexible hours, including evenings and weekends as needed.
• Experience in ambulatory care, community health care, or medical/surgical settings preferred.
• Excellent communication skills for nurse-physician interactions and team collaboration.