Remote RN Quality Assurance Manager, Clinical Systems

CareOregon; Portland (OR); Remote; USD 141,000 - 172,000; Full time

Benefits offered by this job

Bonus - 5% SIP Target

Job summary

CareOregon is seeking an RN Quality Assurance Manager for Clinical Systems to lead QA for decision tools used in utilization management. You will oversee multiple teams, collaborate with Clinical Operations, and drive internal QA processes, dashboards, and vendor testing to meet quality standards and compliance.

You will train staff, implement improvements, and manage documentation while ensuring alignment with Medicare/Medicaid guidelines and organizational goals.

Qualifications

• Current unrestricted RN license for Oregon.
• 5+ years in health plan quality operations or utilization management.
• Experience with clinical content and testing.
• Experience directing vendor testing and QA processes.
• Strong knowledge of regulatory requirements (Medicare/Medicaid) and quality improvement.

Responsibilities

• Lead and supervise multiple QA teams for clinical systems and decision tools.
• Develop and maintain QA testing processes, dashboards, and reports.
• Coordinate with Clinical Operations and other CareOregon teams.
• Ensure compliance with regulatory and contractual requirements.
• Provide training and remediation outcomes across departments.

Skills

Leadership

Quality Assurance

Utilization Management

Training

Data Analysis

Project Management

Communication

Change Management

Clinical Content Creation

Vendor Testing

Education

RN License (Oregon)

Tools

InterQual

MCG

Job description

CareOregon is seeking an RN Quality Assurance Manager for Clinical Systems to lead QA for decision tools used in utilization management. You will oversee multiple teams, collaborate with Clinical Operations, and drive internal QA processes, dashboards, and vendor testing to meet quality standards and compliance.

You will train staff, implement improvements, and manage documentation while ensuring alignment with Medicare/Medicaid guidelines and organizational goals.