Remote Clinical Quality & HEDIS Analyst

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

Job summary

Blue Cross and Blue Shield of North Carolina is seeking a Clinical Quality Management Analyst for a Remote Flex role. The position evaluates staff and provider performance, conducts quality audits, and develops learning solutions to close identified gaps, aligning with regulatory requirements and Corporate Medical Policy.

You will support data-driven decisions and collaborate with vendors to improve quality outcomes.

Qualifications

• RN with 3 years of clinical experience or LPN with 5 years of clinical experience required.
• Experience in UM, CM, Medical Review or quality programs preferred.
• Bachelor’s degree or advanced degree preferred.

Responsibilities

• Conduct quality audits of staff and providers to ensure compliance with departmental objectives and regulatory requirements.
• Develop learning solutions based on audit findings and performance gaps.
• Monitor, analyze, and report benchmarking and trend analyses for improvement.
• Provide guidance on interpretation of clinical aspects of policies to assist clinical decisions.
• Assist with vendor relationships and data element changes (Ellkay/CDX).
• Present audit findings to vendors and BCNC staff and support data-driven decisions.

Skills

HEDIS knowledge

Analytical skills

Communication skills

Clinical auditing

Vendor relations

Education

Bachelor’s degree or higher

Job description

Blue Cross and Blue Shield of North Carolina is seeking a Clinical Quality Management Analyst for a Remote Flex role. The position evaluates staff and provider performance, conducts quality audits, and develops learning solutions to close identified gaps, aligning with regulatory requirements and Corporate Medical Policy.

You will support data-driven decisions and collaborate with vendors to improve quality outcomes.