Quality Assurance Nurse Manager

Quality Assurance Nurse Manager Overview

• The Quality Assurance Nurse Manager will oversee quality improvement initiatives and ensure compliance with HEDIS and NCQA standards.
• Collaborate with providers and internal teams to address quality-of-care concerns and improve patient outcomes.
• Provide clinical oversight and supervision to Wellness RNs and Health Educators, ensuring effective execution of quality assurance projects.
• Engage in data analysis, performance evaluation, and trend identification to recommend quality enhancements.
• Participate in community outreach events, health fairs, and vaccination initiatives as needed.
• Educate members on chronic conditions and promote healthier lifestyle behaviors.
• Work in a hybrid environment, alternating weekly between in-office and remote work.

Quality Assurance Nurse Manager Key Responsibilities & Duties

• Develop and coordinate goals and outcomes using HEDIS specifications for quality improvement plans.
• Review charts and population-based data required by HEDIS or quality improvement processes.
• Monitor and address gaps in care for various chronic conditions among providers and groups.
• Serve as a clinical liaison between the organization and providers on quality-of-care concerns.
• Supervise Wellness RNs and Health Educators, ensuring adherence to quality assurance protocols.
• Participate in seasonal vaccination programs and community health events as required.
• Analyze performance data, identify trends, and collaborate with business leads to recommend improvements.

Quality Assurance Nurse Manager Job Requirements

• Valid New York State Registered Nurse (RN) license; BSN preferred.
• Minimum three years of quality improvement experience and two years of management experience.
• Strong knowledge of HEDIS, NCQA, and quality improvement processes.
• Experience in clinical assessment, patient education, and motivational interviewing.
• Intermediate proficiency in Microsoft Outlook, Word, and Excel preferred.
• Bilingual in Spanish and a valid NYS driver’s license are preferred.
• Ability to work flexible hours, including evenings and weekends, as needed.