California Licensed Clinical Quality Administrator

Job Summary

California Licensed Clinical Quality Administrator, responsible for overseeing grievance and Potential Quality Issue (PQI) programs, ensuring regulatory compliance, and managing a team, in a full-time remote position.

Key Responsibilities

• Provide operational direction for grievance and PQI activities, ensuring compliance with internal workflows and health plan expectations
• Serve as the subject-matter expert during the transition to a unified market solution, advising on requirements and workflow impacts
• Oversee the accuracy of case documentation and manage escalated grievances in collaboration with clinical and operational leadership

Required Qualifications

• Current, unrestricted RN/LVN license in California
• 2+ years of experience in Quality Improvement, managed care, or clinical quality review
• Leadership or team-lead experience
• Experience with health plans, audits, and regulatory bodies (e.g., DMHC, CMS)
• Proven ability to interpret and apply regulatory standards to ensure compliant workflows