Remote Clinical Quality & HEDIS Analyst

Blue Cross and Blue Shield of North Carolina; Texas; Híbrido; USD 74.000 - 118.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, dental, and vision coverage

401k with company match

Paid time off

Descripción de la vacante

Blue Cross and Blue Shield of North Carolina is hiring a Clinical Quality Management Analyst to evaluate, analyze, and monitor staff or provider performance to achieve excellence in quality. You will deliver timely, objective feedback and develop learning solutions to close identified gaps, while ensuring compliance with regulatory requirements and internal policies.

You will partner with the management team to support workflow improvements, data-driven decision making, and ongoing

Formación

• RN with 3 years of clinical experience or LPN with 5 years of clinical experience required.
• Bachelor's degree or advanced degree preferred.

Responsabilidades

• Conduct quality audits of staff and providers to ensure compliance with departmental objectives, regulatory requirements, policies, and procedures.
• Support development of learning solutions based on quality audit findings and identified performance gaps.
• Monitor, analyze, and report individual and departmental performance results, including benchmarking, trend analysis, and opportunities for continuous improvement.
• Provide guidance with interpretation of clinical aspects of policies and clinical guidelines to assist in medical decisions, aligning with regulatory requirements.
• Assist with data element changes and vendor-related data activities.

Conocimientos

Quality audits

Regulatory compliance

Data analysis

Clinical decision support

Vendor management

Educación

RN license

Bachelor's degree preferred

Herramientas

Ellkay/CDX

Descripción del empleo

Blue Cross and Blue Shield of North Carolina is hiring a Clinical Quality Management Analyst to evaluate, analyze, and monitor staff or provider performance to achieve excellence in quality. You will deliver timely, objective feedback and develop learning solutions to close identified gaps, while ensuring compliance with regulatory requirements and internal policies.

You will partner with the management team to support workflow improvements, data-driven decision making, and ongoing