Remote Clinical Quality & HEDIS Analyst

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

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

401k match

PTO

Tuition reimbursement

Parental leave

Adoption assistance

Job summary

Blue Cross NC is seeking a Clinical Quality Management Analyst to evaluate staff and provider performance, and to drive quality improvements. You will translate audit findings into targeted learning solutions, monitor performance, and support data-driven decision-making in a remote-flex environment.

The role requires RN or LPN with relevant clinical experience and a preferred Bachelor’s or higher. You will collaborate with management, vendors, and cross-functional teams to uphold regulatory

Qualifications

• Experience performing quality audits to ensure regulatory and policy compliance.
• Ability to translate audit findings into actionable learning solutions.
• Strong data interpretation, trend analysis, and reporting skills.

Responsibilities

• Conduct quality audits of staff and providers and report findings.
• Provide guidance on clinical decision-making and regulatory alignment.
• Support workflow improvements and data-driven decisions.
• Assist with IPP Host Plan requests and vendor interactions.
• Monitor HEDIS performance and benchmark results.

Skills

Quality audits

Clinical knowledge

Data analysis

Regulatory compliance

Learning solutions

Education

RN licensure

LPN licensure

Bachelor's degree preferred

Advanced degree preferred

Tools

Ellkay/CDX

Job description

Blue Cross NC is seeking a Clinical Quality Management Analyst to evaluate staff and provider performance, and to drive quality improvements. You will translate audit findings into targeted learning solutions, monitor performance, and support data-driven decision-making in a remote-flex environment.

The role requires RN or LPN with relevant clinical experience and a preferred Bachelor’s or higher. You will collaborate with management, vendors, and cross-functional teams to uphold regulatory