Remote-Flex Clinical Quality & HEDIS Analyst

Blue Cross and Blue Shield of North Carolina; Arkansas; À distance; USD 74 000 - 118 000; Plein temps

Avantages offerts par ce poste

Medical, dental, and vision coverage

401k match with employer contributions

Paid time off (PTO)

Parental leave and adoption support

Tuition reimbursement

Flexible work options

Résumé du poste

Blue Cross NC is seeking a Clinical Quality Management Analyst to join the Clinical Quality Reporting & Compliance Team. You will evaluate staff and provider performance, provide actionable feedback, and develop learning solutions tied to quality findings.

You will conduct audits to ensure compliance with regulatory requirements, guide clinical decision-making, and support data-driven improvements across departments.

Qualifications

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

Responsabilités

• Conduct quality audits of staff and providers to ensure compliance with policies and regulations.
• Develop learning solutions from audit findings and performance gaps.
• Monitor, analyze, and report performance with benchmarking and trends.
• Provide clinical guidance aligned with corporate policy and regulatory rules.
• Manage vendor relationships and assist with data elements changes.
• Perform IPP Host Plan requests and assist with user setup for vendor messaging.

Connaissances

Clinical experience

Quality improvement

Data analysis

Formation

Bachelor's degree or advanced degree preferred

Description du poste

Blue Cross NC is seeking a Clinical Quality Management Analyst to join the Clinical Quality Reporting & Compliance Team. You will evaluate staff and provider performance, provide actionable feedback, and develop learning solutions tied to quality findings.

You will conduct audits to ensure compliance with regulatory requirements, guide clinical decision-making, and support data-driven improvements across departments.