Network Hospital Quality Coordinator

Blue Cross & Blue Shield of Mississippi; Flowood (MS); On-site; USD 70,000 - 95,000; Full time

Job summary

Blue Cross & Blue Shield of Mississippi invites you to join as a Network Hospital Quality Coordinator, leading data-driven quality initiatives across network hospitals and providers.

You will develop and monitor improvement plans, ensure compliance with CMS and Joint Commission standards, and present results to drive better patient outcomes in Mississippi.

Qualifications

• Bachelor’s degree in a business-related field or clinical designation (e.g., RN).
• Five years of healthcare administration and/or clinical experience.
• Experience analyzing and trending healthcare data.
• Experience in developing and implementing provider/hospital quality improvement programs.
• Proficiency using Microsoft Word and Excel.
• Ability to work with a flexible schedule and moderate travel.
• Working knowledge of healthcare quality related to providers.
• Ability to analyze complex data sets to define performance metrics.
• Proven ability to lead projects from conception to completion.
• Strong interpersonal skills to build relationships with diverse teams.
• Ability to maintain confidentiality and communicate clearly in writing.

Responsibilities

• Review data and KPIs to identify trends and areas for improvement.
• Develop and monitor quality improvement projects aligned with CQM and value-based initiatives.
• Ensure adherence to CMS, The Joint Commission, and state regulations.
• Conduct audit projects and develop corrective action plans for gaps.
• Research best practices and update measures to align with clinical and reimbursement programs.
• Present actionable data to improve performance and public trust.

Skills

Data analysis

Quality improvement

Project leadership

Interpersonal skills

Written communication

Verbal communication

Confidentiality

Education

Bachelor’s degree in business-related field

Clinical designation such as RN

Master’s degree in healthcare administration or nursing

Tools

Microsoft Word

Microsoft Excel

Microsoft Access

Visio

Job description

Be part of a vision for a healthier Mississippi as a Network Hospital Quality Coordinator.

At Blue Cross & Blue Shield of Mississippi, we’re not just about providing health insurance, we are creating a strong, supportive community which encourages every Mississippian to live their healthiest life. This mission requires a talented and motivated team with diverse sets of skills and experiences, aligned with the commitment of a healthy Mississippi. By combining strong financial stewardship with a focus on the Health & Wellness of Mississippians, we invest in programs, partnerships, and innovations which drive quality care, lower costs, and healthier lives.

Join our team and start a meaningful career where your work supports better health outcomes for Mississippians every day.

We are seeking a Network Hospital Quality Coordinator to drive data driven decision making which enhances the quality of care provided by Network Hospitals and Providers using the Comprehensive Quality Model and align with regulatory, accreditation and safety standards. This Quality Coordinator acts in partnership with Hospitals and Providers to develop and implement improvement plans based on evidence‑based best practices and value‑based initiatives.

What You’ll Do:

• Review data and key performance indicators (KPIs) to identify trends, benchmark against standards and pinpoint areas for improvement.
• Develop, implement and monitor quality improvement projects based on evidence‑based practices in alignment with the Comprehensive Quality Model (CQM) and other value‑based initiatives.
• Ensure adherence to federal and state regulations, as well as standards from organizations such as Centers for Medicare & Medicaid Services(CMS) and The Joint Commission.
• Conducts audit projects and develops corrective action plans for identified gaps.
• Research methods and best practices for clinical care, recommending updates to existing measures to align clinical best practice research and reimbursement programs.
• Present actionable data to improve performance, build trust and enhance public brand.

Job‑Specific Requirements:

• Bachelor’s degree in a business‑related field, or clinical designation, such as R.N.
• Five years of healthcare administration and/or clinical experience.
• Experience analyzing and trending healthcare related data.
• Experience in the development and implementation of provider/hospital quality improvement programs and activities intending to monitor/improve health related outcomes.
• Proficiency using Microsoft Word and Excel.
• Ability to work when required, on a flexible schedule and with moderate travel.
• Working knowledge and expertise of healthcare quality, particularly as it relates to providers.
• Ability to analyze complex data sets to define and develop performance metrics.
• Proven ability to lead projects from conception to completion.
• Strong interpersonal skills to build solid business relationships and collaborate with diverse teams including medical providers, frontline staff and those from other Blue Plans or Blue Cross Blue Shield Association.
• Work with a high degree of accuracy.
• Ability to manage and maintain confidentiality of information.
• Strong verbal communication skills to facilitate multidisciplinary meetings and drive continuous improvement and improve patient care while maintaining the capacity to build consensus effectively.
• Written communication skills to ensure that documentations and reports are accurate, detailed and clear, using proper medical terminology to prevent life‑threatening misinterpretations.

Preferred include:

• Master’s degree in healthcare administration or nursing.
• Experience with Microsoft Access and Visio.
• Knowledge of accreditation programs such as The Joint Commission, Det Norske Veritas (DNV) and National Committee for Quality Assurance (NCQA).
• Knowledge of value‑based programs such as Bundled Payments for Care Improvement (BPCI) and Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
• Knowledge of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), International Classification of Diseases, Tenth Revision (ICD10), Uniform Billing (UB) Revenue and National Drug Code (NDC) coding.
• Knowledge of High Reliability Organizations’ quality improvement methodologies and/or certification in quality process improvement.

Why Join Us

• Purpose‑Driven Work: Make a meaningful impact on the Health & Wellness of our Members.
• Learning & Development: Build foundational knowledge in finance and investment accounting.
• Career Growth: Clear pathways to grow your career where your skills flourish, including Treasury, Financial Reporting, Accounting Operations, Internal Audit, etc.
• Healthy Culture: Work in an environment with a focus on your health which allows you to thrive. The walking track, onsite gym and café are just a few of the highlights of the campus.
• Compensation & Benefits: We offer a highly competitive compensation package that includes medical benefits, 401(k), ample paid time off and a schedule that supports true work/life balance

Blue Cross & Blue Shield of Mississippi is an Equal opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.