Clinical Quality & HEDIS Analyst (Remote)

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

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

401k match

Paid time off

Tuition reimbursement

Parental leave and adoption assistance

Job summary

Blue Cross NC is seeking a Clinical Quality Management Analyst to evaluate and monitor clinician and staff performance, offering feedback and implementing action plans for improvement. The role supports development of learning solutions based on quality findings and tracks performance trends across departments.

You will interpret clinical guidance, ensure regulatory alignment, and collaborate with management on workflow and change initiatives, while assisting with vendor relationships and data

Qualifications

• RN with at least 3 years of clinical experience or LPN with 5 years.
• 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 objectives, regulatory requirements, policies and procedures.
• Support development of learning solutions based on audit findings and performance gaps.
• Monitor, analyze and report individual and department performance results, including benchmarking and trend analysis.
• Provide clinical guidance and interpretation of clinical policies to assist in medical decisions, aligning with regulatory requirements.
• Assist with vendor-related data changes and system access tasks as needed.
• Design and present findings from quality audits to staff and vendors.

Skills

RN with 3 years of clinical experience

LPN with 5 years of clinical ervaring

Quality improvement knowledge

Education

Bachelor's degree or advanced degree

Job description

Blue Cross NC is seeking a Clinical Quality Management Analyst to evaluate and monitor clinician and staff performance, offering feedback and implementing action plans for improvement. The role supports development of learning solutions based on quality findings and tracks performance trends across departments.

You will interpret clinical guidance, ensure regulatory alignment, and collaborate with management on workflow and change initiatives, while assisting with vendor relationships and data