Remote Quality & Compliance Analyst — HEDIS Focus

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

Benefits offered by this job

Medical, dental, and vision coverage

401k match

Paid time off

Parental leave and adoption/surrogacy

Tuition reimbursement

Job summary

Blue Cross NC seeks a Clinical Quality Management Analyst to evaluate and monitor staff or provider performance, delivering actionable feedback and learning solutions to close identified gaps. You will support data-driven decisions and align clinical processes with regulatory requirements.

The role involves quality audits of member records, development of learning solutions, and collaboration with management and vendors.

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.
• Bachelor's degree or advanced degree preferred.

Responsibilities

• Conduct quality audits of staff and providers to ensure compliance with departmental objectives, regulatory requirements, policies, and procedures.
• Provide guidance on clinical decision making and interpretation of clinical guidelines to assist in medical decisions and align with regulatory requirements.
• Monitor and report performance results including benchmarking and trend analysis for continuous improvement.

Skills

Clinical experience

Analytical skills

Communication skills

Education

Bachelor's degree or advanced degree

Job description

Blue Cross NC seeks a Clinical Quality Management Analyst to evaluate and monitor staff or provider performance, delivering actionable feedback and learning solutions to close identified gaps. You will support data-driven decisions and align clinical processes with regulatory requirements.

The role involves quality audits of member records, development of learning solutions, and collaboration with management and vendors.