Remote Clinical Quality & Compliance Analyst

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

Benefits offered by this job

Medical, dental, and vision coverage

Parental leave and surrogacy support

Tuition reimbursement

401k match

Job summary

Blue Cross NC is seeking a Clinical Quality Management Analyst to join the Clinical Quality Reporting & Compliance Team. The role evaluates, analyzes, and monitors staff and provider performance to ensure excellence in quality and to provide actionable feedback and learning solutions.

You will conduct quality audits, guide clinical decision-making, and support workflow improvements while coordinating with management and vendors. Remote Flex role with occasional in-office visits as needed.

Qualifications

• RN with 3 years of clinical experience or LPN with 5 years of clinical experience required.
• Must have previous work experience in applicable business area (i.e. 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, regulatory requirements, policies, and procedures.
• Develop learning solutions based on audit findings and performance gaps.
• Monitor, analyze, and report individual and departmental performance results, including benchmarking and trends.
• Assist with changes and administrative tasks related to vendor relationships and data elements.

Skills

RN experience

LPN experience

Education

Bachelor's degree preferred

Job description

Blue Cross NC is seeking a Clinical Quality Management Analyst to join the Clinical Quality Reporting & Compliance Team. The role evaluates, analyzes, and monitors staff and provider performance to ensure excellence in quality and to provide actionable feedback and learning solutions.

You will conduct quality audits, guide clinical decision-making, and support workflow improvements while coordinating with management and vendors. Remote Flex role with occasional in-office visits as needed.