Clinical Quality Coordinator – Hybrid Quality Review

Blue Shield of CA; Los Angeles (CA); Hybrid; USD 65,000 - 85,000; Full time

Job summary

Blue Shield of CA is seeking a Clinical Quality Coordinator to support the Clinical Quality Review (CQR) team in investigating PQIs and member grievances. You will coordinate with providers to obtain medical records and facilitate reviews, contributing to process improvements across care quality.

The role supports a hybrid virtual work model with periodic office presence as needed to meet business demands.

Qualifications

• Strong verbal and written communication skills.
• Basic knowledge of PC-based software including Microsoft Suite and Adobe Acrobat.
• Basic knowledge of managed care principles and benefit plans per line of business (HMO, PPO, Medicare) preferred.
• Basic knowledge of regulatory and accreditation agencies (DMHC, DHCS, CMS, NCQA) preferred.

Responsibilities

• Request medical records and responses from providers to facilitate clinical review by CQR staff.

Skills

Verbal & written communication

Managed care principles

Regulatory knowledge

Education

High school Diploma or GED

Tools

Microsoft Office

Adobe Acrobat

Job description

Blue Shield of CA is seeking a Clinical Quality Coordinator to support the Clinical Quality Review (CQR) team in investigating PQIs and member grievances. You will coordinate with providers to obtain medical records and facilitate reviews, contributing to process improvements across care quality.

The role supports a hybrid virtual work model with periodic office presence as needed to meet business demands.