Clinical Quality Assurance Analyst

Johns Hopkins Health Plans is a leader in provider-sponsored health plans. If you are interested in improving how healthcare is delivered, and have a passion to be at the forefront of change, JHHP is the place to call home. YOU belong here.
What awaits you:

• Work-life balance - This is a remote role!
• Medical, Dental, and Vision Insurance.
• 403B Savings Plan w/employer contribution.
• Paid Time off & Paid holidays.
• Employee and Dependent Tuition assistance benefits.
• Health and wellness programs and MORE!

Who you are:
As the Quality Assurance Nurse Analyst for Johns Hopkins Health Plans, you play a crucial role in supporting our Managed Care Clinical Health Services team by ensuring adherence to high-quality standards through effective Quality Assurance (QA) practices and oversight. You understand the importance of your role as you collaborate with departmental management and key stakeholders, conducting quality audits, feedback sessions, and other quality audits for our Clinical team.
What you'll do:

• Collaborate with departmental management and stakeholders to identify areas that require quality auditing oversight and monitoring.
• Assist in the development of monitoring activities to ensure compliance with quality standards.
• Prepare and analyze quality audit reports to identify data integrity issues, performance gaps, and process gaps.
• Conduct quality audits, feedback sessions, and other quality audit functions for Health Services staff.
  • You will focus on key areas such as Utilization Management, Intake (inpatient and outpatient), Clinical Appeals, Complaints and Grievance, Care Management, Behavioral Health, Medical Directors, and/or other relevant areas
• Participate in testing and QA of system changes as necessary.
• Collaborate with key stakeholders and Training Staff to provide feedback and contribute to the improvement of processes and procedures.
• Serve as a clinical expert in the development and evaluation of quality audit functions.
• Develop and maintain service level agreements, standard operating procedures, workflows, and educational materials.

What you'll bring:

• 5+ years' experience as a RN in Managed Care
  • In depth knowledge of NCQA, CMS, and State Mandated Quality Measures is required
• Must be familiar with managed care operations, including utilization review, care management, behavioral health, and clinical appeals
• Ability to effectively communicate, provide constructive feedback, and facilitate positive interdepartmental relationships
• Ability to work in multiple software applications and learn new applications quickly.
• Unencumbered RN license in Maryland (or Compact licensure)

Who we are:
Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine. JHHP is a $3B business serving over 500,000 active members with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHP is a leader in provider-sponsored health plans and is poised for future growth.
Many organizations talk about transforming the future of healthcare, at Johns Hopkins Health Plans, we are setting the pace for change within the healthcare industry. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for our members and the communities we serve.
Johns Hopkins Health System and its affiliates are an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.
Johns Hopkins Health System and its affiliates are drug-free workplace employers.