[Remote] Senior Quality Assurance Nurse Manager at Gravie

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

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 actionable insights

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

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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