Remote Clinical Quality & Compliance Analyst

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

Benefits offered by this job

Medical, dental, and vision coverage

Tuition reimbursement

401k match

Job summary

Blue Cross NC is seeking a Clinical Quality Management Analyst to evaluate, analyze, and monitor staff or provider performance, delivering feedback and action plans to improve quality. The role supports learning solutions and ensures alignment with regulatory requirements and corporate medical policy.

The candidate will conduct quality audits, report performance results, and assist in data-driven decision making while collaborating with management and vendors in a remote/Hybrid Flex environment.

Qualifications

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

Responsibilities

• Conduct quality audits of staff and providers to ensure compliance with policies and regulatory requirements.
• Develop learning solutions based on audit findings and performance gaps.
• Provide guidance on clinical decision making and interpret clinical guidelines.

Skills

Analytical skills

Communication

Problem solving

Education

Bachelor's degree

Advanced degree

Job description

Blue Cross NC is seeking a Clinical Quality Management Analyst to evaluate, analyze, and monitor staff or provider performance, delivering feedback and action plans to improve quality. The role supports learning solutions and ensures alignment with regulatory requirements and corporate medical policy.

The candidate will conduct quality audits, report performance results, and assist in data-driven decision making while collaborating with management and vendors in a remote/Hybrid Flex environment.