Remote Clinical Quality Improvement Analyst

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

Benefits offered by this job

Medical, dental, and vision coverage

401k with employer match

Paid Time Off (PTO)

Tuition reimbursement

Job summary

Blue Cross NC is seeking a Clinical Quality Management Analyst to evaluate and monitor staff and provider performance, delivering actionable feedback and recommendations to close quality gaps. The role supports learning solutions and data-driven decision-making across the Clinical Quality Reporting & Compliance Team.

The position emphasizes regulatory alignment, HEDIS measures, and collaboration with management to improve workflow processes and outcomes.

Qualifications

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

Responsibilities

• Perform quality audits of staff and providers to ensure compliance with departmental objectives, policies, and regulatory requirements.
• Provide guidance on clinical decision-making aligned with regulatory requirements and clinical guidelines.
• Develop learning solutions based on audit findings and performance gaps; present findings to vendors/BCNC staff.
• Monitor and report performance results, including benchmarking and trend analyses, to drive continuous improvement.
• Assist with vendor relationships and manage vendor communications as needed.

Skills

Analytical skills

Organizational skills

Problem-solving

Written communication

Verbal communication

Education

Bachelor's degree

Advanced degree

Job description

Blue Cross NC is seeking a Clinical Quality Management Analyst to evaluate and monitor staff and provider performance, delivering actionable feedback and recommendations to close quality gaps. The role supports learning solutions and data-driven decision-making across the Clinical Quality Reporting & Compliance Team.

The position emphasizes regulatory alignment, HEDIS measures, and collaboration with management to improve workflow processes and outcomes.