RN Quality Assurance Manager, Clinical Systems (Remote)

Embedded Shishya; United States; Remote; USD 141,000 - 172,000; Full time

Benefits offered by this job

Bonus - SIP Target 5% Annual

Job summary

CareOregon seeks an RN Quality Assurance Manager for Clinical Systems to provide leadership for utilization management tools, staff training, and QA processes. This role oversees multiple teams, aligning clinical content with Medicare/Medicaid guidelines and driving continuous improvement across departments.

The position emphasizes collaboration with Clinical Operations, development of dashboards, and ensuring quality standards are met. Strong leadership and regulatory knowledge are essential.

Qualifications

• Current unrestricted RN license for state of Oregon.
• Minimum five years in health plan quality operations (e.g., utilization management).
• Preferred supervisory experience and knowledge of InterQual/MCG guidelines.

Responsibilities

• Develop and oversee implementation of department policies and procedures.
• Lead training, audits, and educational resources for staff.
• Conduct process trainings and support quality planning.
• Ensure regulatory compliance and plan of correction activities.
• Collaborate with Clinical Operations to align with Medicare/Medicaid standards.
• Create and maintain QA testing content and documentation.
• Analyze data to identify improvement opportunities and communicate results.

Skills

Communication

Leadership

Project management

Teamwork

Attention to detail

Education

RN license (Oregon)

Job description

CareOregon seeks an RN Quality Assurance Manager for Clinical Systems to provide leadership for utilization management tools, staff training, and QA processes. This role oversees multiple teams, aligning clinical content with Medicare/Medicaid guidelines and driving continuous improvement across departments.

The position emphasizes collaboration with Clinical Operations, development of dashboards, and ensuring quality standards are met. Strong leadership and regulatory knowledge are essential.