Remote Clinical Quality & Compliance Analyst

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

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Wellness programs

Parental leave and surrogacy support

Career development and tuition Reimb.

401k match with annual company, etc.

Learn more

Job summary

Blue Cross NC is seeking a Clinical Quality Management Analyst to join the Clinical Quality Reporting & Compliance Team. You will evaluate staff/provider performance, provide actionable feedback, and help design learning solutions to close quality gaps.

This role requires strong analytical skills and familiarity with HEDIS and regulatory requirements. The position offers Remote Flex with occasional in-office visits and national scope for hiring.

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 and regulatory requirements.
• Develop learning solutions based on audit findings and performance gaps.
• Monitor, analyze, and report performance results including benchmarking and trends.
• Provide guidance on clinical decision making and interpret clinical guidelines.
• Assist with vendor relationships and administrative tasks as needed.

Skills

Analytical skills

Problem-solving

Communication skills

Clinical knowledge

Education

Bachelor's degree

Advanced degree

Tools

Ellkay/CDX

Job description

Blue Cross NC is seeking a Clinical Quality Management Analyst to join the Clinical Quality Reporting & Compliance Team. You will evaluate staff/provider performance, provide actionable feedback, and help design learning solutions to close quality gaps.

This role requires strong analytical skills and familiarity with HEDIS and regulatory requirements. The position offers Remote Flex with occasional in-office visits and national scope for hiring.