Remote Clinical Quality & HEDIS Analyst

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

Benefits offered by this job

Medical, dental, and vision coverage

Parental leave and adoption assistance

401k match

Tuition reimbursement

Paid Time Off

Job summary

Blue Cross NC is seeking a Clinical Quality Management Analyst to evaluate and monitor staff or provider performance, provide timely feedback, and develop targeted learning solutions to close quality gaps. You will contribute to data-driven decision-making and support regulatory alignment across the organization.

The role includes conducting quality audits for HEDIS specifications, interpreting clinical policies, and managing vendor relationships in a remote-flex environment.

Qualifications

• RN with 3 years clinical experience or LPN with 5 years clinical experience.
• 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 identified performance gaps.
• Monitor, analyze, and report individual and departmental performance results, including benchmarking and trend analysis.

Skills

RN with 3 years clinical experience

LPN with 5 years clinical experience

Education

Bachelor's degree

Advanced degree

Job description

Blue Cross NC is seeking a Clinical Quality Management Analyst to evaluate and monitor staff or provider performance, provide timely feedback, and develop targeted learning solutions to close quality gaps. You will contribute to data-driven decision-making and support regulatory alignment across the organization.

The role includes conducting quality audits for HEDIS specifications, interpreting clinical policies, and managing vendor relationships in a remote-flex environment.