Senior Quality Assurance Nurse Manager

Responsibilities

• Provide strategic and operational leadership to registered nurses and allied clinical staff
• Oversee daily operations, ensuring efficient workflows and appropriate staffing levels
• Participate in coordinating and developing Quality Improvement initiatives and monitor performance metrics and outcomes
• Review generic charts and other population-based data to identify trends, gaps, and opportunities for quality improvement across chronic conditions for provider groups and individual providers, then address them
• Serve as a clinical liaison between the Fund and Providers on quality-of-care concerns (HEDIS and other Performance Measures)
• Review performance, evaluate effectiveness, analyze data, identify trends, and collaborate with business leads to recommend enhancements
• Engage Fund Registered Nurses (RN), Health Educators (HE), and Social Workers (SW) in quality assurance projects, such as outreach to members with gaps in care
• Assist Medical Director in hiring, recruiting, onboarding and evaluation of clinical staff
• Provide supervision, mentoring, coaching, and clinical oversight of all Wellness clinical staff to strengthen competencies.
• Educate members regarding acute and chronic conditions and promote healthier lifestyle behaviors.
• Participate in seasonal vaccination and other types of testing as needed.
• Participate in Health Fairs, Screenings, and Outreach Events in New York City and outer borough locations as needed
• Perform additional duties and projects, as assigned by management
• Ability to work flexible hours including evenings and weekends as needed Qualifications
• A valid New York State Registered Nurse (RN) license is required; Bachelor’s degree required
• Minimum of six (6) years of nursing experience in ambulatory care, community health care, or medical/surgical settings, including at least three (3) years in quality improvement and four (4) years in management required
• Strong experience in clinical assessment, patient education, motivational interviewing, critical thinking, independent decision-making, quality assurance, and quality improvement
• Excellent nurse-physician communication, leadership, coaching, and team-building skills are required.
• Knowledge of Healthcare Effectiveness Data and Information Set (HEDIS) and National Committee for Quality Assurance (NCQA)
• Intermediate computer and digital literacy
• Basic proficiency in Microsoft Outlook, Word, and Excel is preferred