UR/QA Manager - DC

LOCATION: ON-SITE in the DISTRICT OF COLUMBIA

SUMMARY

Provides clinical, operational, and quality assurance leadership in the coordination and oversight of healthcare and transportation-related services. Ensures compliance with regulatory, contractual, and organizational standards through utilization review, quality assurance activities, risk management, staff training, and continuous process improvement. Serves as a clinical subject matter expert and liaison to medical facilities, community organizations, and internal teams while promoting high-quality customer service and operational excellence.

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ESSENTIAL FUNCTIONS

Clinical & Operational Oversight

• Performs thorough review of assessments, diagnoses, and service requests to determine appropriateness of care and transportation services.
• Coordinates service delivery and monitors service-related issues to ensure continuity of care, program compliance, and customer satisfaction.
• Identifies risks, implements safety plans, and collaborates with interdisciplinary teams to address clinical and operational concerns.
• Serves as a representative to medical facilities and community partners regarding healthcare and transportation services.

Quality Assurance & Compliance

• Plans, coordinates, and directs quality assurance and utilization review activities to ensure compliance with company policies, contractual requirements, and regulatory standards.
• Conducts audits, analyzes quality data, and applies process improvement methods to enhance operational performance.
• Maintains knowledge of healthcare regulations, accreditation standards, and quality assurance requirements.
• Investigates customer complaints and develops corrective action plans to improve service quality.
• Supports accreditation initiatives and organizational compliance programs.

Education & Community Relations

• Develops and facilitates training, outreach, and in-service programs for staff, healthcare providers, and community organizations.
• Builds and maintains relationships with healthcare facilities, community agencies, and stakeholders.
• Provides presentations and educational resources related to healthcare services, quality standards, and transportation coordination.

Administrative & Leadership Responsibilities

• Keeps leadership informed of significant operational, quality, compliance, and customer service issues.
• Supervises and supports staff involved in quality assurance, utilization review, and service coordination activities.
• Assists with development and implementation of policies, procedures, and continuous improvement initiatives.
• Performs additional duties as assigned.
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QUALIFICATIONS REQUIRED

• Registered Nurse (RN) degree required.
• Minimum three (3) years of clinical nursing experience with direct patient care experience preferred.
• Experience in utilization review, quality assurance, healthcare compliance, or managed care environment preferred.
• Knowledge of Medicare, Medicaid, community resources, dialysis, and nursing home placement processes.
• Strong understanding of quality assurance principles, regulatory compliance, and process improvement methods.
• Demonstrated leadership, organizational, and problem-solving skills.
• Excellent written, verbal, interpersonal, and customer service communication skills.
• Ability to work effectively within interdisciplinary teams and manage multiple priorities in a fast-paced environment.
• Proficiency in Microsoft Office Suite, including Word and Excel.
• Ability to maintain confidentiality and handle sensitive information professionally.
• Flexible, self-directed, and able to work independently or collaboratively within a team environment.