Senior Quality Assurance Nurse Manager

Hi we’re Gravie. Our mission is to improve the way people purchase and access healthcare through innovative consumer-centric health benefit solutions that people can actually use. Our industry-changing products and services are developed and delivered by a diverse group of unique people. We encourage you to be your authentic self - we like you that way.

A Little More About The role:

The Senior Quality Assurance Nurse plays a critical role in ensuring Gravie’s clinical operations are compliant efficient and centered on delivering high-quality care to members. This role supports operational excellence regulatory readiness and quality assurance across all clinical programs while preparing the organization for future accreditation (URAC/NCQA) and the strategic development of in-house Utilization Management (UM).

You will:

·       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.

You bring:

·       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.

Extra credit:

·       Previous start-up company experience

Gravie:

In order to transform health insurance and build a health plan everyone can love we need talented people doing amazing work. In exchange we offer a great overall employee experience with opportunities for career growth meaningful mission-driven work and an above average total rewards package.

The salary range for this position is $108750 - $181250 annually. Numerous factors including but not limited to educations skills work experience certifications etc. will be considered when determining compensation.

Our unique benefits program is the gravy i.e. the special sauce that sets our compensation package apart. In addition to standard health and wellness benefits Gravie’s package includes alternative medicine coverage flexible PTO up to 16 weeks paid parental leave paid holidays a 401k program cell phone reimbursement transportation perks education reimbursement and 1 week of paid paw-ternity leave.

A Little More About Us:

At Gravie we're on a mission to reinvent health benefits for small and midsize businesses—making high-quality affordable healthcare accessible to employers and their employees. We believe better benefits lead to better lives and we’re building the future of health benefits to reflect just that.

We’re proud to be the only company offering both innovative level-funded health plans and a market-leading ICHRA solution giving employers more choice and flexibility than ever before.

And guess what? Our customers love us. With member and employer satisfaction rates consistently trending above 80% we know our health plans are working the way they should. Backed by some of the most sought-after investors in the country we have the resources and long-term support to build something truly transformative—and we’re just getting started.

At Gravie we do things differently. We’ll challenge you and we’ll welcome you challenging us. Good ideas are everyone's job here. You’ll join a team that’s smart mission-driven and unafraid to push boundaries if it means making a bigger impact for the people we serve.

If you're energized by a high-performance high-trust environment where your voice matters Gravie might be just the place for you.