Remote Clinical Quality Analyst - HEDIS & Compliance

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

Benefits offered by this job

Medical, dental and vision coverage

Parental leave and surrogacy support

Career development programs and degree

401k with company match

Work-life balance and wellness

Job summary

Blue Cross NC invites applications for a Clinical Quality Management Analyst to join the Clinical Quality Reporting & Compliance Team. This role evaluates performance, providing feedback and action plans to staff, providers and management to improve quality and compliance.

The analyst develops learning solutions from audit findings, supports regulatory alignment, and oversees data elements and vendor interactions while tracking performance trends and benchmarking.

Qualifications

• RN or LPN with clinical experience in UM/CM/Medical Review
• Bachelor's degree or higher preferred
• Experience in clinical quality programs and analytics is a plus

Responsibilities

• Audit staff and providers for compliance with objectives, policies and regulations; support learning solutions based on findings
• Develop and present quality audit results with actionable recommendations
• Monitor, benchmark and trend performance; support data-driven decisions
• Provide clinical guidance aligning decision-making with regulatory requirements (DOI/ERISA/NCQA)
• Assist with data element changes (Ellkay/CDX) and vendor messaging setup
• Design and deliver learning solutions from audit insights and educate vendors/BCNC staff
• Manage vendor relationships and support ongoing program administration

Skills

RN experience

LPN experience

Education

Bachelor's degree

Job description

Blue Cross NC invites applications for a Clinical Quality Management Analyst to join the Clinical Quality Reporting & Compliance Team. This role evaluates performance, providing feedback and action plans to staff, providers and management to improve quality and compliance.

The analyst develops learning solutions from audit findings, supports regulatory alignment, and oversees data elements and vendor interactions while tracking performance trends and benchmarking.