Quality Management Specialist - RN - Hybrid (PA/NJ/DE) jobs in United States
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Independence Blue Cross · 6 days ago

Quality Management Specialist - RN - Hybrid (PA/NJ/DE)

positionPhiladelphia, PA
timeFull-time
remoteHybrid
senioritySenior Level
date5+ years exp

Independence Blue Cross is focused on enhancing the health and well-being of the communities they serve. They are seeking a Quality Management Specialist - RN to address regulatory and accreditation requirements, analyze reports, and coordinate quality management activities.

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H1B Sponsor Likelynote

Responsibilities

Maintain all NCQA Accreditation statuses for PA and NJ health plans and AHA
Monitor the overarching NCQA Work Plan and oversee QM team leads with assigned NCQA Standards
Collaborate with operational depts. in developing an action plan to close identified gaps
Review current occurrence and quality of care complaint processes and complete ongoing investigations of occurrences and quality of care complaints
Review ongoing medical and behavioral treatment to ensure treatment is consistent with standards of care
Coordinate aspects of the monthly Quality Meetings as necessary
Complete assigned QM documents with accuracy and within the required timeframes

Qualification

Registered Nurse (RN)Managed care experienceRegulatory requirements knowledgeBehavioral health experienceAnalytical skillsOrganizational skillsInterpersonal skillsPresentation skillsWritten communicationTime managementTeam collaboration

Required

Registered Nurse (RN) licensed to practice
Minimum of five (5) years of progressive responsibility required in a managed care setting
Familiarity of regulatory and accreditation requirements required
Excellent organizational, interpersonal, analytical, presentation and written skills required
Demonstrated ability to interact effectively with all levels of staff
Excellent interpersonal, verbal and written communication skills
Must have an organized work manner inclusive of time management and the ability to prioritize workflow
Proven ability to work independently, maintain flexibility, and work as part of the departmental team
Leads and /or facilitates clinical performance improvement teams/taskforce as indicated
Serves as a team facilitator and consultative resource for clinical and departmental leadership and staff

Preferred

Preferred three (3) years of behavioral health, and/or drug and alcohol work experience

Company

Independence Blue Cross

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The leading health insurer in southeastern Pennsylvania. It is a sub-organization of Independence Blue Cross.
dateFounded in 1938
location
Philadelphia, Pennsylvania, USA
people-size5001-10000 employees
web-link
https://www.ibx.com

H1B Sponsorship

Independence Blue Cross has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (16)
2024 (2)
2023 (6)
2022 (2)
2021 (6)
2020 (1)

Funding

Current Stage
Late Stage

Leadership Team

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Alexandra Jorgensen
Senior Vice President Human Resources
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Joe Geist
SVP & Market President, National
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