Clinical & Operations Oversight

Provides clinical, operational, and quality assurance leadership in the coordination and oversight of healthcare and transportation-related services. Ensures compliance with regulatory, contractual, and organizational standards through utilization review, quality assurance activities, risk management, staff training, and continuous process improvement. Serves as a clinical subject matter expert and liaison to medical facilities, community organizations, and internal teams while promoting high-quality customer service and operational excellence.

Essential Functions:

Clinical & Operational Oversight

· Performs thorough review of assessments, diagnoses, and service requests to determine appropriateness of care and transportation services.

· Coordinates service delivery and monitors service-related issues to ensure continuity of care, program compliance, and customer satisfaction.

· Identifies risks, implements safety plans, and collaborates with interdisciplinary teams to address clinical and operational concerns.

· Serves as a representative to medical facilities and community partners regarding healthcare and transportation services.

Quality Assurance & Compliance

· Plans, coordinates, and directs quality assurance and utilization review activities to ensure compliance with company policies, contractual requirements, and regulatory standards.

· Conducts audits, analyzes quality data, and applies process improvement methods to enhance operational performance.

· Maintains knowledge of healthcare regulations, accreditation standards, and quality assurance requirements.

· Investigates customer complaints and develops corrective action plans to improve service quality.

· Supports accreditation initiatives and organizational compliance programs.

Education & Community Relations

· Develops and facilitates training, outreach, and in-service programs for staff, healthcare providers, and community organizations.

· Builds and maintains relationships with healthcare facilities, community agencies, and stakeholders.

· Provides presentations and educational resources related to healthcare services, quality standards, and transportation coordination.

Administrative & Leadership Responsibilities

· Keeps leadership informed of significant operational, quality, compliance, and customer service issues.

· Supervises and supports staff involved in quality assurance, utilization review, and service coordination activities.

· Assists with development and implementation of policies, procedures, and continuous improvement initiatives.

· Performs additional duties as assigned.

QUALIFICATIONS REQUIRED

· Registered Nurse (RN) degree required.

· Minimum three (3) years of clinical nursing experience with direct patient care experience preferred.

· Experience in utilization review, quality assurance, healthcare compliance, or managed care environment preferred.

· Knowledge of Medicare, Medicaid, community resources, dialysis, and nursing home placement processes.

· Strong understanding of quality assurance principles, regulatory compliance, and process improvement methods.

· Demonstrated leadership, organizational, and problem-solving skills.

· Excellent written, verbal, interpersonal, and customer service communication skills.

· Ability to work effectively within interdisciplinary teams and manage multiple priorities in a fast-paced environment.

· Proficiency in Microsoft Office Suite, including Word and Excel.

· Ability to maintain confidentiality and handle sensitive information professionally.

· Flexible, self-directed, and able to work independently or collaboratively within a team environment.