Clinical Quality Review Specialist - Hybrid

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

Job summary

Blue Shield of California is seeking a Clinical Quality Coordinator to join the Clinical Quality Review (CQR) team in San Diego. You will help manage medical records requests and support clinical reviews to improve member care.

The role emphasizes collaboration, attention to detail, and effective communication with providers and internal teams; hybrid work with periods in the office as needed.

Qualifications

• Requires a high school diploma or GED or equivalent experience
• Minimum 3 years of relevant experience
• Strong verbal and written communication skills
• Basic knowledge of PC-based software including Microsoft Suite and Adobe Acrobat
• Knowledge of managed care principles and regulatory bodies preferred

Responsibilities

• Request medical records and responses from providers to support clinical review
• Coordinate with CQR staff to prepare cases for review
• Assist in documenting findings and communicating with providers

Skills

Strong verbal and written comms

Attention to detail

Team collaboration

Education

High school diploma or GED or 1 year relevant experience

3 years of prior relevant experience

Tools

Microsoft Office

Adobe Acrobat

Job description

Blue Shield of California is seeking a Clinical Quality Coordinator to join the Clinical Quality Review (CQR) team in San Diego. You will help manage medical records requests and support clinical reviews to improve member care.

The role emphasizes collaboration, attention to detail, and effective communication with providers and internal teams; hybrid work with periods in the office as needed.