Clinical Quality Nurse Manager

Job Summary

A company is looking for a Clinical Quality Call Center Nurse Manager - Remote.

Key Responsibilities

• Supervise and coordinate a team to ensure compliance with regulatory initiatives and performance targets
• Handle escalated calls and assist members with inquiries
• Conduct performance reviews and support leadership in monitoring metrics for STAR performance

Required Qualifications

• Undergraduate degree or equivalent experience
• 5+ years of managerial experience in a healthcare setting
• Extensive knowledge of Medicare Part D, including pharmacy record review and billing rules
• Working knowledge of HIPAA Privacy and Security Rules and CMS security requirements
• Prior work experience in STARS and clinical Medicare Part C gap closures