Remote Clinical Quality & Compliance Analyst

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

Benefits offered by this job

Medical/Dental/Vision

Parental leave

Tuition reimbursement

401k match

Wellness programs

Job summary

Blue Cross NC is seeking a Clinical Quality Management Analyst to evaluate staff and provider performance and deliver actionable feedback with improvement plans. You will support learning solutions aligned with quality audits and regulatory requirements.

You’ll work with management to drive workflow improvements, monitor performance, and report trends. Remote-flex role with occasional in-office visits, and strong emphasis on HEDIS-related activities and data integrity.

Qualifications

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

Responsibilities

• Conduct quality audits of staff and providers to ensure compliance with objectives, regulations, policies and procedures.
• Develop learning solutions based on audit findings and performance gaps.
• Monitor, analyze, and report performance results including benchmarking and trends.

Skills

Quality audits

Performance analysis

Learning solutions

Education

BSN/RN licensure

LPN licensure

Bachelor’s degree preferred

Job description

Blue Cross NC is seeking a Clinical Quality Management Analyst to evaluate staff and provider performance and deliver actionable feedback with improvement plans. You will support learning solutions aligned with quality audits and regulatory requirements.

You’ll work with management to drive workflow improvements, monitor performance, and report trends. Remote-flex role with occasional in-office visits, and strong emphasis on HEDIS-related activities and data integrity.