- Remote, United States
- Remote
- Full-time · Manager
- $100K–$125K per year
- 5+ years
Lead and manage the Quality Management Program, ensuring compliance, accreditation, and continuous improvement across clinical and physician review activities.
Compensation
The base salary range for this position is $100,000 to $125,000 annually. This represents the base pay range that we reasonably expect to offer for this position. In addition to base pay, this role may be eligible for performance-based bonuses, incentive pay, or commissions, which are not included in the listed base salary range.
Responsibilities
- Lead the Quality Management Program, including annual program evaluation, quality improvement initiatives, KPI development, performance monitoring, and implementation of continuous process improvements.
- Identify compliance, accreditation, contractual, and operational risks; conduct root cause analyses; develop corrective action plans; monitor effectiveness of interventions; and escalates significant issues as appropriate.
- Develop, implement, and oversee quality audit programs for clinical and physician review activities, including IRR audits, adverse determination reviews, and data integrity audits.
- Ensure audit findings are accurate, consistent, defensible, and supported by standardized methodologies, appropriate sampling techniques, and regulatory requirements.
- Maintain expertise in utilization management workflows, policies, and operational processes to ensure meaningful oversight and auditing activities.
Requirements
- Bachelor's degree in Nursing
- RN license