Clinical Quality & Compliance Analyst (Remote Flex)

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

Benefits offered by this job

Medical, dental, vision coverage

Parental leave & adoption support

401k match

Tuition reimbursement

Career development programs

Job summary

Blue Cross NC is seeking a Clinical Quality Management Analyst to join the Clinical Quality Reporting & Compliance Team. You will evaluate staff and provider performance, conduct quality audits, and provide actionable feedback with improvement plans.

You will develop learning solutions from audit findings, monitor performance trends, support regulatory alignment (HEDIS/DOI/ERISA), and collaborate with management and vendors to drive quality improvements in a remote-flex environment.

Qualifications

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

Responsibilities

• Conduct quality audits of staff and providers to ensure compliance with policies and regulatory requirements.
• Develop learning solutions based on audit findings and identified performance gaps.
• Monitor and report performance results with benchmarking and trend analysis.

Skills

Clinical experience

Education

Bachelor's degree

Advanced degree

Job description

Blue Cross NC is seeking a Clinical Quality Management Analyst to join the Clinical Quality Reporting & Compliance Team. You will evaluate staff and provider performance, conduct quality audits, and provide actionable feedback with improvement plans.

You will develop learning solutions from audit findings, monitor performance trends, support regulatory alignment (HEDIS/DOI/ERISA), and collaborate with management and vendors to drive quality improvements in a remote-flex environment.