Quality Management Specialist - LHB }

Responsibilities

• Coordinate and implement Quality Improvement Activities and Initiatives for the Healthcare Management Division
• Ensure compliance with state, federal, and accreditation requirements
• Manage licensure, regulatory standards, audits, and policy development
• Lead quality improvement activities by coordinating committees and monitoring performance metrics
• Conduct audits and root cause analyses
• Oversee accreditation and customer satisfaction processes
• Serve as a regulatory and quality compliance resource across the organization

Requirements

• Active Unrestricted Registered Nurse License (USA)
• Minimum 3 years clinical experience (e.g., medical/surgical, community health, or home health)
• Ability to read and interpret policy manuals and criteria
• Strong oral and written communication skills
• Ability to work independently with minimal supervision
• Proficiency in computing rates, ratios, and percentages

Preferred Qualifications

• Prior Quality Management experience in a managed care setting
• URAC/NCQA Accreditation experience
• Bachelor of Science in Nursing (BSN)

About the Company

Luminare Health, a wholly owned subsidiary of Health Care Service Corporation (HCSC), is a leading third-party administrator dedicated to making healthcare simpler, better, and more affordable.