Clinical Quality Analyst & Learning Solutions (Remote)

Blue Cross and Blue Shield of North Carolina; Louisiana; Remote; USD 74,000 - 118,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

401(k) match

Tuition reimbursement

Parental leave and surrogacy support

Career development programs

Job summary

Blue Cross and Blue Shield of North Carolina is seeking a Clinical Quality Management Analyst to evaluate provider performance, drive quality improvement, and support learning solutions based on audit findings. This remote-flex role emphasizes data-driven decision-making and collaboration with management and vendors.

The incumbent will conduct audits, interpret clinical guidelines, ensure regulatory compliance, and help design solutions to improve HEDIS outcomes while supporting various program

Qualifications

• RN with 3 years of clinical experience or LPN with 5 years of clinical experience required.
• Experience in UM, CM, Medical Review or quality programs preferred.
• Bachelor's degree or advanced degree preferred.

Responsibilities

• Conduct quality audits of staff and providers to ensure compliance with departmental objectives, regulatory requirements, policies, and procedures.
• Develop learning solutions based on audit findings and performance gaps.
• Monitor, analyze, and report performance results including benchmarking and trends.
• Provide guidance on clinical decisions and interpret clinical guidelines to aid decisions.
• Assist with IPP Host Plan requests and vendor data changes.
• Present findings to vendors/BCNC staff and support change efforts across teams.

Skills

Quality audits

Data analysis

Regulatory compliance

Learning solutions

Communication

Education

RN license

Bachelor's degree preferred

Tools

HEDIS data extraction

Clinical guidelines interpretation

Job description

Blue Cross and Blue Shield of North Carolina is seeking a Clinical Quality Management Analyst to evaluate provider performance, drive quality improvement, and support learning solutions based on audit findings. This remote-flex role emphasizes data-driven decision-making and collaboration with management and vendors.

The incumbent will conduct audits, interpret clinical guidelines, ensure regulatory compliance, and help design solutions to improve HEDIS outcomes while supporting various program