Clinical Quality Assurance Nurse Analyst
: Job Details :

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. Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine. YOU belong here.What you will do:As the Clinical 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 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!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 HealthCare (JHHC) is the managed care and health services business of Johns Hopkins Medicine. JHHC 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. JHHC 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 HealthCare, 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. If you are interested in improving how healthcare is delivered, and have a passion to be at the forefront of change, JHHC is the place to call home.Salary Range: Minimum 39.94 per hour - Maximum 61.91 per hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility.In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority.JHM prioritizes the health and well-being of every employee. Come be healthy at Hopkins!Diversity and Inclusion are Johns Hopkins Medicine Core Values. We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.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.