RN Quality Assurance Leader, Clinical Systems

CareOregon; United States; Hybrid; USD 141,000 - 172,000; Full time

Benefits offered by this job

Bonus - SIP Target 5%

Total rewards program

Job summary

CareOregon is seeking an RN Quality Assurance Manager, Clinical Systems to lead QA across clinical systems, ensuring compliant utilization management and high-quality content. You will oversee training, develop dashboards, and collaborate with Clinical Operations to align with Medicare/Medicaid requirements.

The role emphasizes cross-functional leadership, process improvement, and supervising staff to deliver timely, accurate QA outcomes while advancing organizational quality standards.

Qualifications

• Current unrestricted RN license for Oregon state.
• Minimum 5 years in health plan quality operations (quality assurance/utilization management).
• Preferred supervisory experience and familiarity with CareOregon programs.

Responsibilities

• Lead and supervise multiple quality assurance teams and projects.
• Develop, implement, and maintain QA testing of clinical content and processes.
• Ensure regulatory compliance and plans of correction across departments.
• Collaborate with Clinical Operations and Medical Directors on improvements.

Skills

RN license

Quality assurance

Utilization management

Project management

Training and development

Regulatory knowledge

Data analysis

Education

Registered Nurse (RN) license

Tools

InterQual

Medicaid/Medicare guidelines

Job description

CareOregon is seeking an RN Quality Assurance Manager, Clinical Systems to lead QA across clinical systems, ensuring compliant utilization management and high-quality content. You will oversee training, develop dashboards, and collaborate with Clinical Operations to align with Medicare/Medicaid requirements.

The role emphasizes cross-functional leadership, process improvement, and supervising staff to deliver timely, accurate QA outcomes while advancing organizational quality standards.