Remote Flex Clinical Quality Compliance Analyst

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

Benefits offered by this job

Medical, dental, vision coverage

Parental leave and surrogacy support

Tuition reimbursement

401k match

Job summary

Blue Cross NC is seeking a Clinical Quality Management Analyst to join the Clinical Quality Reporting & Compliance Team. You will evaluate, analyze, and monitor staff or provider performance to drive quality excellence and supply actionable feedback with improvement plans.

You’ll conduct quality audits to ensure regulatory and departmental compliance, develop learning solutions from findings, and report benchmarks and trends to inform data-driven decisions at all management levels.

Qualifications

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

Responsibilities

• Conduct quality audits of staff and providers to ensure compliance with policies, procedures and regulatory requirements.
• Develop learning solutions based on audit findings and performance gaps.
• Monitor and report performance results, including benchmarking and trends.
• Assist with vendor relationships and data element changes (Ellkay/CDX).
• Provide guidance on clinical decision-making aligned with regulatory requirements.

Skills

Quality audits

Data analysis

Regulatory compliance

Clinical decision support

Education

Bachelor's degree or advanced degree

Tools

Ellkay/CDX

Job description

Blue Cross NC is seeking a Clinical Quality Management Analyst to join the Clinical Quality Reporting & Compliance Team. You will evaluate, analyze, and monitor staff or provider performance to drive quality excellence and supply actionable feedback with improvement plans.

You’ll conduct quality audits to ensure regulatory and departmental compliance, develop learning solutions from findings, and report benchmarks and trends to inform data-driven decisions at all management levels.