Remote Clinical Quality & HEDIS Analyst

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

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 to drive excellence in quality, offering feedback and action plans when deficiencies are found.

You will conduct quality audits, support learning solutions based on findings, analyze performance with benchmarking and trends, and assist in coordinating vendor relationships and clinical decision support while

Qualifications

• RN with 3 years of clinical experience or LPN with 5 years of clinical experience.
• Previous 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 departmental objectives, regulatory requirements, policies, and procedures.
• Assist staff with learning solutions based on quality audit findings and identified performance gaps.
• Monitor, analyze, and report performance results including benchmarking and trend analysis.
• Assist with Ellkay/CDX changes in data elements and set up new vendor users.”
• Perform quality audits of member medical records to ensure compliance with HEDIS specifications.

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. This role evaluates and monitors staff or provider performance to drive excellence in quality, offering feedback and action plans when deficiencies are found.

You will conduct quality audits, support learning solutions based on findings, analyze performance with benchmarking and trends, and assist in coordinating vendor relationships and clinical decision support while