RN, Clinical Ops QA & Improvement Lead

MedStar Health; Columbia (MD); On-site; USD 89,000 - 163,000; Full time

Job summary

MedStar Family Choice seeks an experienced Clinical Operations Quality Assurance and Improvement RN to lead design and ongoing advancement of quality training, auditing, compliance and performance improvement programs across Clinical Operations for DC and Maryland.

The role acts as the SME for documentation integrity NCQA standards utilization management and regulatory compliance, partnering with leaders to standardize processes and drive measurable improvements.

Qualifications

• 3-4 years Case Management and utilization review experience.
• 3-4 years Clinical training auditing quality improvement staff development and/or regulatory compliance experience.
• 1-2 years Experience in NCQA accreditation managed care organization / health plan preferred.

Responsibilities

• Design, implement and monitor quality training and education programs.
• Administer and maintain audit programs for clinical operations and documentation.
• Lead regulatory compliance, NCQA readiness and accreditation activities.
• Analyze performance data to identify opportunities and drive improvements.
• Collaborate with leadership to implement workflow and process enhancements.

Skills

Quality Assurance

Training & Education

Auditing & Compliance

Clinical Operations

Data Analytics

Education

Bachelor's degree in Nursing

Master's degree Healthcare or Nursing

Job description

MedStar Family Choice seeks an experienced Clinical Operations Quality Assurance and Improvement RN to lead design and ongoing advancement of quality training, auditing, compliance and performance improvement programs across Clinical Operations for DC and Maryland.

The role acts as the SME for documentation integrity NCQA standards utilization management and regulatory compliance, partnering with leaders to standardize processes and drive measurable improvements.