Nsure Healthcare · 8 hours ago
Manager, Quality and Risk
United States
Full-time
Remote
Senior Level
$125K/yr - $140K/yr
5+ years expNsure Healthcare is focused on delivering high-quality telehealth and care management services. The Manager of Quality & Risk oversees clinical quality, patient safety, and regulatory risk management, ensuring compliance with standards while identifying and mitigating risks across programs.
BillingHealth CareMedicalSoftware
Responsibilities
Lead quality assurance activities across care management programs and pilots (CCM, PCM, RPM, CoCM, RTM, Heart Failure)
Develop, maintain, and monitor quality metrics, KPIs, and outcome measures
Conduct routine chart audits and documentation reviews to ensure clinical accuracy, completeness, and compliance
Identify trends in quality gaps, adverse events, and near misses; recommend corrective actions
Support continuous quality improvement (CQI) initiatives and performance improvement plans
Identify, assess, and mitigate clinical and operational risks related to patient safety, escalation, and care delivery
Develop and oversee incident reporting, investigation, root cause analysis, and follow-up
Develop and oversee patient complaint management system, investigation, root cause analysis, and follow-up
Ensure timely escalation of high-risk clinical scenarios in alignment with organizational protocols
Collaborate with leadership to implement risk mitigation strategies and monitor effectiveness
Ensure clinical workflows and documentation align with CMS requirements, payer policies, and applicable regulations
Support audit preparedness and response, including internal audits and external reviews
Partner with Compliance and Legal teams on policy development, updates, and staff education
Monitor regulatory changes and assess impact on clinical operations and risk exposure
Develop and deliver education related to quality standards, risk management, and best practices
Support onboarding and ongoing training for clinical staff related to documentation, escalation, and safety
Participate in clinical governance committees and contribute to protocol development and updates
Analyze quality and risk data to identify trends, opportunities, and emerging risks
Prepare quality and risk reports for clinical leadership and executive review
Collaborate with analytics teams to ensure accurate data capture and meaningful reporting
Qualification
Required
Active RN license or comparable credentials
Bachelor's degree required; Master's degree in nursing, public health, healthcare administration, or related field preferred
5+ years of clinical experience, including care management or telehealth environments
Demonstrated experience in quality assurance, risk management, or compliance
Strong knowledge of CMS care management programs and documentation requirements
Experience with chart auditing and quality improvement methodologies
Preferred
Experience supporting CCM, CoCM, RPM, PCM, or RTM programs
Familiarity with value-based care and population health models
Experience in telehealth or remote clinical operations
Certification in Quality, Risk Management, or Patient Safety (e.g., CPHQ, CPPS) a plus
Company
Nsure Healthcare
Nsure helps hundreds of healthcare providers accelerate cash flow and increase efficiency throughout the country.
11-50 employees
Funding
Current Stage
Early StageLeadership Team
Michael Ciullo
Founder & CEO
Recent News
Fintech Schweiz Digital Finance News - FintechNewsCH
2025-11-29
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