Remote Clinical Quality & Compliance Analyst

Blue Cross and Blue Shield of North Carolina; Wyoming; 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 and career dev

401k match with company contribution

PTO and wellness programs

Job summary

Blue Cross NC is seeking a Clinical Quality Management Analyst to join the Clinical Quality Reporting & Compliance Team. This role evaluates and monitors staff or provider performance, providing feedback and action plans to ensure compliance with policies and regulatory requirements.

You will conduct quality audits, develop learning solutions based on findings, and monitor performance with benchmarking and trend analyses to drive continuous improvement.

Qualifications

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

Responsibilities

• Conduct quality audits of staff and providers to ensure compliance with departmental objectives, regulatory requirements, policies, and procedures.
• Develop learning solutions based on quality audit findings and performance gaps.
• Monitor, analyze, and report performance with benchmarking and trend analysis for continuous improvement.

Skills

RN with 3 years clinical experience

LPN with 5 years clinical experience

Quality/UM/Medical Review experience

Education

Bachelor's degree or higher

Job description

Blue Cross NC is seeking a Clinical Quality Management Analyst to join the Clinical Quality Reporting & Compliance Team. This role evaluates and monitors staff or provider performance, providing feedback and action plans to ensure compliance with policies and regulatory requirements.

You will conduct quality audits, develop learning solutions based on findings, and monitor performance with benchmarking and trend analyses to drive continuous improvement.