Remote Clinical Quality & Compliance Analyst

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

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Parental leave

Tuition reimbursement

401k match

Career development

Job summary

Blue Cross NC is hiring a Clinical Quality Management Analyst to evaluate staff and provider performance, develop learning solutions, and drive quality improvements across the organization. You will monitor results, report trends, and support regulatory alignment through data-driven decision making.

The role requires RN with 3 years (or LPN with 5 years) of clinical experience, and a Bachelor's degree is preferred.

Qualifications

• Experience conducting quality audits of staff or providers.
• Knowledge of HEDIS specifications and clinical measures.
• Ability to analyze performance data and identify improvement opportunities.

Responsibilities

• Conduct quality audits to ensure compliance with objectives, policies, and procedures.
• Develop learning solutions based on audit findings and performance gaps.
• Monitor, analyze, and report performance with benchmarking and trends.
• Provide guidance on clinical policy interpretation and regulatory alignment.
• Assist with vendor relationships and data element changes.

Skills

Quality audits

HEDIS knowledge

Clinical decision support

Data analysis

Education

Bachelor's degree

Job description

Blue Cross NC is hiring a Clinical Quality Management Analyst to evaluate staff and provider performance, develop learning solutions, and drive quality improvements across the organization. You will monitor results, report trends, and support regulatory alignment through data-driven decision making.

The role requires RN with 3 years (or LPN with 5 years) of clinical experience, and a Bachelor's degree is preferred.