Remote Clinical Quality & HEDIS Analyst

Blue Cross and Blue Shield of North Carolina; Ohio; Hybride; USD 74 000 - 118 000; Plein temps

Avantages offerts par ce poste

Medical, dental, and vision coverage

Parental leave and surrogacy support

401k match

Résumé du poste

Blue Cross NC is seeking a Clinical Quality Management Analyst to evaluate and monitor staff and provider performance to drive quality improvements. You will develop learning solutions, analyze data, and report on performance with benchmarking and trends.

The role requires clinical experience and a strong understanding of regulatory alignment. You will collaborate with management and vendors, assist with system changes and credentialing, and participate in improving HEDIS measures and patient

Qualifications

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

Responsabilités

• Conduct quality audits of staff and providers to ensure compliance with objectives and regulations.
• Develop learning solutions based on audit findings and performance gaps.
• Monitor, analyze, and report performance results with benchmarking and trends.
• Provide guidance on clinical decision making aligned with regulatory requirements.
• Assist with vendor changes and set up user access for messaging systems.
• Perform quality audits of member medical records per HEDIS specifications.
• Present audit findings to vendors and BCNC staff.
• Support ongoing administration of larger programs and vendor relationships.

Connaissances

Analytical skills

Communication skills

Formation

RN with 3 years clinical experience

LPN with 5 years clinical experience

Bachelor's degree or advanced degree preferred

Description du poste

Blue Cross NC is seeking a Clinical Quality Management Analyst to evaluate and monitor staff and provider performance to drive quality improvements. You will develop learning solutions, analyze data, and report on performance with benchmarking and trends.

The role requires clinical experience and a strong understanding of regulatory alignment. You will collaborate with management and vendors, assist with system changes and credentialing, and participate in improving HEDIS measures and patient