[Remote] Senior Quality Assurance Nurse Manager at Gravie

Remote

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Active, unrestricted Registered Nurse (RN) license
Bachelor’s degree in nursing (BSN) or related field, preferred
7+ years of clinical experience, with at least 3–5 years in quality assurance, compliance, or accreditation within a health plan, managed care, or healthcare operations environment
Strong leadership with demonstrated ability to interface with senior leaders and different levels of organization
Deep understanding of UM/CM processes, regulatory requirements, and accreditation standards (URAC, NCQA, CMS)
Strong analytical and problem-solving skills with demonstrated ability to translate data into action

Responsibilities

Design, implement, and manage a comprehensive Clinical Quality Program with embedded QA processes across Utilization Management (UM), Case Management (CM), Care Navigation, Pharmacy, Clinical Stop Loss/Underwriting, and Clinical insights within Health Plan Operations
Partner with Vendor Oversight to ensure quality and compliance standards are upheld across all clinical vendors and partners
Lead continuous improvement initiatives to enhance the effectiveness and consistency of clinical operations
Ensure compliance with state and federal regulations, including all relevant CMS, URAC, and NCQA standards
Maintain and oversee all clinical licensure requirements (nursing and pharmacy)
Develop and maintain policies and procedures that align with regulatory and accreditation standards
Prepare the organization for external reviews, audits, and accreditation surveys
Lead the tracking, trending, and analysis of clinical performance data to identify risks, inform strategy, and support leadership decision-making
Develop and manage departmental KPIs, performance metrics, and benchmarking to monitor program effectiveness and quality outcomes
Oversee the tracking and resolution of grievances, incident reports, and adverse events
Provide clear, data-driven insights to Clinical Operations Leadership on opportunities for improvement
Partner with cross-functional leaders to embed QA principles and processes across all clinical departments
Develop and deliver regular training sessions for clinical and operational staff related to quality standards, compliance, and continuous improvement initiatives
Serve as a resource and subject matter expert on clinical quality assurance, compliance, and accreditation standards

Skills

Key technologies and capabilities for this role

Quality AssuranceUtilization ManagementCase ManagementCare NavigationRegulatory ComplianceCMSURACNCQAVendor OversightClinical OperationsNursing LicensurePharmacy LicensurePolicies and ProceduresAudits

Questions & Answers

Common questions about this position

What is the employment type for this role?

This is a full-time position.

What salary or compensation is offered for the Senior Quality Assurance Nurse Manager role?

This information is not specified in the job description.

What are the key responsibilities and skills needed for this position?

The role requires expertise in designing and managing clinical quality programs, ensuring regulatory compliance with CMS, URAC, and NCQA standards, leading data analysis and continuous improvement initiatives, and overseeing clinical licensure and vendor partnerships.

What is the company culture like at Gravie?

Gravie fosters a diverse, authentic work environment focused on innovative, consumer-centric health solutions, encouraging employees to be their authentic selves.

What makes a strong candidate for this Senior Quality Assurance Nurse Manager role?

Strong candidates will have deep experience in clinical quality assurance, regulatory compliance (CMS, URAC, NCQA), utilization management, data-driven decision-making, and leading cross-functional teams in healthcare operations.

Gravie

Health benefits and insurance solutions provider

About Gravie

Gravie provides health benefits by offering straightforward and affordable health plans, primarily targeting individuals and small to midsize businesses. Their main product, Comfort, stands out because it has no deductible and no copays for most common healthcare services, allowing members to access care without unexpected costs. Additionally, Comfort includes virtual care options for musculoskeletal and mental health issues. Gravie also offers a payment solution called Gravie Pay, which enables members to pay for healthcare expenses interest-free, further easing financial stress. Unlike traditional health plans, Gravie claims that Comfort members save on out-of-pocket costs, and employers switching to Gravie often see lower premium expenses. The company has a high retention rate, indicating that many employees choose to continue with the Comfort plan in subsequent years. Gravie's goal is to simplify health benefits and reduce the financial burden of healthcare for its members.

Minneapolis, MinnesotaHeadquarters

2013Year Founded

$333.3MTotal Funding

DEBTCompany Stage

Fintech, HealthcareIndustries

201-500Employees

Benefits

Health Insurance

401(k) Retirement Plan

401(k) Company Match

Paid Holidays

Paid Vacation

Paid Sick Leave

Flexible Work Hours

Paid Parental Leave

Wellness Program

Alternative Medicine Coverage

Cell Phone Reimbursement

Transportation Perks

Education Reimbursement

Paid Paw-ternity Leave

Risks

Potential backlash from traditional insurers could increase competition or lobbying.

Rapid ICHRA adoption may invite regulatory scrutiny or changes.

Aggressive expansion strategy could strain resources and lead to inefficiencies.

Differentiation

Gravie's Comfort plan offers zero deductibles and copays, unlike traditional health plans.

Gravie Pay provides interest-free payment solutions, reducing financial burdens for members.

Focus on virtual healthcare services enhances accessibility and member satisfaction.

Upsides

Increased ICHRA adoption since 2020 expands Gravie's market opportunities.

Comfort plan's zero-deductible model attracts cost-conscious employers and employees.

Virtual healthcare services align with rising demand, boosting member engagement.

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