Job Description
📋 Description Design and manage a Clinical Quality Program with QA across UM, CM, Care Navigation, Pharmacy. Partner with Vendor Oversight to ensure quality and compliance across vendors. Lead continuous improvements to enhance clinical operations. Ensure compliance with CMS, URAC, NCQA and other regs. Maintain licensure requirements for nursing and pharmacy. Develop and maintain policies aligning with regulatory standards. 🎯 Requirements Active, unrestricted RN license. BSN or related field, preferred. 7+ years clinical experience with 3–5 years in QA/compliance. 3+ years of leadership experience. Deep understanding of UM/CM, URAC, NCQA, CMS. Strong analytical and problem-solving skills with data insights. 🎁 Benefits Health and wellness benefits. Alternative medicine coverage. Flexible PTO. Up to 16 weeks paid parental leave. Paid holidays. 401k program.
