Remote Clinical Quality Auditor & Improvement Analyst

Blue Cross and Blue Shield of North Carolina; Missouri; Ibrido; USD 74.000 - 118.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical, dental, and vision coverage

Parental leave and adoption support

401k match

Tuition reimbursement

Paid time off

Descrizione del lavoro

Blue Cross NC is seeking a Clinical Quality Management Analyst to join the Clinical Quality Reporting & Compliance Team. The role evaluates staff and provider performance, delivers feedback with action plans, and supports learning solutions to improve quality outcomes.

Responsibilities include conducting quality audits, analyzing performance data, guiding clinical decision making, and coordinating vendor activities. A nursing background and HEDIS knowledge are highly valued.

Competenze

• RN with 3 years of clinical experience or LPN with 5 years of clinical experience.
• Previous work experience in UM, CM, Medical Review or quality programs.
• Bachelor's degree or advanced degree preferred.

Mansioni

• Conduct quality audits of staff and providers to ensure compliance with objectives and regulatory requirements.
• Analyze performance data, benchmark results and trends for continuous improvement.
• Provide guidance on clinical policy interpretations and medical decision making.
• Develop learning solutions based on audit findings and support vendor interactions.
• Assist with vendor management and data element changes (e.g., Ellkay/CDX).
• Support IPP Host Plan requests and password resets for users as needed.
• Report on HEDIS performance and department results to management.

Conoscenze

Quality audits

Data analysis

Analytical thinking

Communication skills

Problem solving

Ability to collaborate

Formazione

Bachelor's degree preferred

Advanced degree preferred

Strumenti

Ellkay/CDX

Descrizione del lavoro

Blue Cross NC is seeking a Clinical Quality Management Analyst to join the Clinical Quality Reporting & Compliance Team. The role evaluates staff and provider performance, delivers feedback with action plans, and supports learning solutions to improve quality outcomes.

Responsibilities include conducting quality audits, analyzing performance data, guiding clinical decision making, and coordinating vendor activities. A nursing background and HEDIS knowledge are highly valued.