Clinical Quality Review Coordinator – Hybrid PQI

Blue Shield of CA; Redding (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 team. You will request medical records and provider responses to enable clinical review by CQR staff and assist with PQI reviews to identify improvement opportunities.

The role emphasizes strong communication, familiarity with PC software, and knowledge of managed care concepts. A hybrid virtual work setup applies, with occasional in-office needs for business operations.

Qualifications

• Requires a High school Diploma or GED or 1 year of additional relevant experience in lieu of a diploma.
• Requires 3 years of prior relevant experience.
• 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.
• Support PQI reviews and identify opportunities for improvement.

Skills

Communication

Verbal & Written

PC proficiency

Healthcare knowledge

Education

High school diploma or GED + relevant experience

Tools

Microsoft Office

Adobe Acrobat

Job description

Blue Shield of CA is seeking a Clinical Quality Coordinator to support the Clinical Quality Review team. You will request medical records and provider responses to enable clinical review by CQR staff and assist with PQI reviews to identify improvement opportunities.

The role emphasizes strong communication, familiarity with PC software, and knowledge of managed care concepts. A hybrid virtual work setup applies, with occasional in-office needs for business operations.