Clinical Quality Review Coordinator II - Hybrid

Blue Shield of CA; Rancho Cordova (CA); Hybrid; USD 60,000 - 85,000; Full time

Benefits offered by this job

Hybrid Virtual Work

Job summary

Blue Shield of California is seeking a Clinical Quality Coordinator to support the Clinical Quality Review (CQR) team. You will request medical records and responses from providers to facilitate clinical review and ensure timely, accurate assessments of PQIs and grievances.

This role emphasizes collaboration with senior leaders, data accuracy, and adherence to regulatory standards, with a hybrid work arrangement that combines remote work and occasional office presence to meet business needs.

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.

Job description

Blue Shield of California is seeking a Clinical Quality Coordinator to support the Clinical Quality Review (CQR) team. You will request medical records and responses from providers to facilitate clinical review and ensure timely, accurate assessments of PQIs and grievances.

This role emphasizes collaboration with senior leaders, data accuracy, and adherence to regulatory standards, with a hybrid work arrangement that combines remote work and occasional office presence to meet business needs.