Remote Clinical Quality & Compliance Analyst

Blue Cross Blue Shield of North Carolina; United States; À distance; USD 74 000 - 118 000; Plein temps

Avantages offerts par ce poste

Medical, dental, and vision coverage

401k with company match

Paid time off (PTO)

Parental leave and adoption support

Tuition reimbursement

Résumé du poste

Blue Cross Blue Shield of North Carolina is seeking a Clinical Quality Management Analyst to evaluate, analyze, and monitor staff or provider performance and drive improvements. You will develop learning solutions, guide clinical decision-making, and support regulatory alignment across QA initiatives.

The role involves auditing member records for HEDIS, managing vendor relationships, and contributing to continuous improvement programs. Remote Flex with some office visits, HQ in Durham area.

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.

Responsabilités

• Conduct quality audits of staff and providers to ensure compliance with objectives and regulations.
• Develop learning solutions based on audit findings and performance gaps.
• Monitor, analyze, and report performance with benchmarking and trend analysis.
• Provide guidance on clinical policy interpretation and regulatory alignment.
• Assist with vendor relationships and data element changes (e.g., Ellkay/CDX).
• Present findings to vendors/BCNC staff and support data-driven decisions.

Connaissances

Quality audits

Analytical skills

Communication skills

HEDIS knowledge

Healthcare payer knowledge

Formation

RN licensure with clinical experience

Bachelor's degree preferred

Description du poste

Blue Cross Blue Shield of North Carolina is seeking a Clinical Quality Management Analyst to evaluate, analyze, and monitor staff or provider performance and drive improvements. You will develop learning solutions, guide clinical decision-making, and support regulatory alignment across QA initiatives.

The role involves auditing member records for HEDIS, managing vendor relationships, and contributing to continuous improvement programs. Remote Flex with some office visits, HQ in Durham area.