Remote Clinical Quality & HEDIS Analyst

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

Benefits offered by this job

Medical, dental, and vision coverage

Parental leave and surrogacy support

Tuition reimbursement

Job summary

Blue Cross NC is seeking a Clinical Quality Management Analyst to join the Clinical Quality Reporting & Compliance Team. The role evaluates staff and provider performance, feeds back with action plans, and supports learning solutions to close gaps in quality.

The candidate will monitor performance, perform HEDIS-related audits, and collaborate with vendors to improve outcomes. Remote-flex role with some in-office visits.

Qualifications

• RN with 3 years of clinical experience or LPN with 5 years of clinical experience.
• Must have prior work experience in 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, regulations, and policies.
• Provide guidance on clinical aspects of policies to assist in medical decisions and align with regulatory requirements.
• Support learning solutions based on quality audit findings and performance gaps.

Skills

Quality auditing

Data analysis

Communication skills

Education

Bachelor's degree or advanced degree

Job description

Blue Cross NC is seeking a Clinical Quality Management Analyst to join the Clinical Quality Reporting & Compliance Team. The role evaluates staff and provider performance, feeds back with action plans, and supports learning solutions to close gaps in quality.

The candidate will monitor performance, perform HEDIS-related audits, and collaborate with vendors to improve outcomes. Remote-flex role with some in-office visits.