RN Quality Improvement Policy Coordinator - South Carolina Hybrid Position

BlueCross BlueShield of South Carolina; Columbia (SC); Hybrid; USD 68,000 - 95,000; Full time

Job summary

Join a distinguished insurance provider as an RN Quality Improvement Policy Coordinator. This role focuses on enhancing quality management through vendor audits, policy development, and compliance monitoring, ensuring excellence in healthcare delivery. Candidates should possess a strong clinical background and effective communication skills, thriving in a hybrid work environment that balances remote work with occasional on-site presence.

Benefits

401(k) retirement savings plan with company match

Subsidized health plans and free vision coverage

Paid annual leave

Tuition assistance

Qualifications

• 4 years clinical or Behavioral Health experience, including 2 years in Quality Management.
• Active RN licensure in the state of hire.
• Excellent understanding of managed care.

Responsibilities

• Performs vendor audits and oversight.
• Conducts quality medical record reviews.
• Writes and updates policies.

Skills

Excellent verbal and written communication

Organizational skills

Analytical and critical thinking

Education

Associates in a job-related field

Tools

Microsoft Office

Excel

PowerPoint

Job description

RN Quality Improvement Policy Coordinator - South Carolina Hybrid Position

Join to apply for the RN Quality Improvement Policy Coordinator - South Carolina Hybrid Position role at BlueCross BlueShield of South Carolina

RN Quality Improvement Policy Coordinator - South Carolina Hybrid Position

3 days ago Be among the first 25 applicants

Join to apply for the RN Quality Improvement Policy Coordinator - South Carolina Hybrid Position role at BlueCross BlueShield of South Carolina

Summary

We are currently hiring for a RN Quality Improvement Policy Coordinator to join BlueCross BlueShield of South Carolina. This individual will perform vendor audits and oversight. They will provide reporting to the vendors, Governance Committee, the executive team, and other stakeholders using Excel and PowerPoint. They must be able to communicate the results and their impact to the various groups. They will write and update policies and manage vendors. They will also collaborate with the Governance Committee and oversight teams on audits and reporting. Strong auditing, policy writing and vendor management will assist in being successful in this role.

Summary

We are currently hiring for a RN Quality Improvement Policy Coordinator to join BlueCross BlueShield of South Carolina. This individual will perform vendor audits and oversight. They will provide reporting to the vendors, Governance Committee, the executive team, and other stakeholders using Excel and PowerPoint. They must be able to communicate the results and their impact to the various groups. They will write and update policies and manage vendors. They will also collaborate with the Governance Committee and oversight teams on audits and reporting. Strong auditing, policy writing and vendor management will assist in being successful in this role.

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future.

Description

Logistics:

• This position is full time (40 hours/week) Monday-Friday and is a hybrid position.
• To work from home, you must have high-speed internet and a private home office. You cannot have satellite internet.
• Candidate must reside in the state of South Carolina.
  
  

Location:

• It will be mainly work from home with working onsite at 17 Technology Circle, Columbia, S.C., 29203 a few times per month.
  
  

Position Purpose

Monitors/implements quality improvement/management activities. Conducts specific medical reviews as necessary, analyzes findings, makes recommendations for corrective actions, and prepares formal documentation for compliance with applicable standards/regulations. Performs Health Plan Employer Data Information Set data collection (HEDIS), and National Committee for Quality Assurance (NCQA) accreditation activities.

What You’ll Do

• Performs quality improvement activities to monitor/maintain compliance with applicable standards/regulations.
• Analyzes/documents/presents findings of quality improvement activities.
• Recommends corrective action and improvement when necessary.
• Conducts quality medical record reviews to monitor quality of care and service provided.
• Tracks/trends/investigates quality concerns and complaints.
• Coordinates HEDIS data collection.
  
  

To Qualify for This Position, You’ll Need the Following:

• Education: Associates in a job-related field.
• Nursing Experience: Four years clinical OR Behavioral Health to include two-years Quality Management experience.
• Skills/Abilities: Excellent verbal and written communication, customer service, organizational, presentation, problem solving, and analytical and critical thinking skills. Proficient spelling, grammar, punctuation, and basic business math. Ability to handle confidential or sensitive information with discretion. Demonstrated ability to identify the need for and implement corrective actions. Strong understanding of managed care.
• License: Active, unrestricted licensure in Behavioral Health from the United States and in the state of hire, OR active, unrestricted RN licensure from the United States and in the state of hire, OR active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC), OR Registered Health Information Administrator (RHIA).
• Software: Microsoft Office.
  
  

We Prefer That You Have The Following

• Experience: Policy Writing and auditing experience in a state or government oversight capacity is strongly preferred. Vendor Management experience. Medicare experience a plus.
• Skills/Abilities: Able to effectively communicate audit results with various stakeholders. Strong attention to detail, very well organized.
• Software: Intermediate Excel and PowerPoint skills experience needed.
  
  

What We Can Do For You

• 401(k) retirement savings plan with company match.
• Subsidized health plans and free vision coverage.
• Life insurance.
• Paid annual leave – the longer you work here, the more you earn.
• Nine paid holidays.
• On-site cafeterias and fitness centers in major locations.
• Wellness programs and healthy lifestyle premium discount.
• Tuition assistance.
• Service recognition.
• Incentive Plan.
• Merit Plan.
• Continuing education funds for additional certifications and certification renewal.
  
  

What To Expect Next

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and salary requirements. Management will be conducting interviews with the most qualified candidates.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email [e-mail] or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information.

Some states have required notifications. Here's more information.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Insurance

Referrals increase your chances of interviewing at BlueCross BlueShield of South Carolina by 2x

Sign in to set job alerts for “Registered Nurse” roles.

Columbia, SC $68,000.00-$95,000.00 5 hours ago

Columbia, SC $70,000.00-$80,000.00 1 month ago

Columbia, SC $1,855.30-$1,855.30 1 week ago

Travel RN – Medical-Surgical/Telemetry & Neurology - $1,860 per week

Columbia, SC $1,859.00-$1,859.00 1 week ago

Gilbert, SC $68,000.00-$95,000.00 17 hours ago

Travel CVICU Registered Nurse - $1,853 per week

Columbia, SC $1,852.00-$1,852.00 1 week ago

Aveanna Healthcare Private Duty Nurse RN - Toddler

Travel Registered Nurse Med Surg / Telemetry

Columbia, SC $2,159.00-$2,159.00 1 week ago

Columbia, SC $1,636.00-$1,636.00 1 week ago

State Park, SC $68,000.00-$95,000.00 5 hours ago

Aveanna Healthcare Private Duty Nurse RN - Feeding Tube Child (Day Shifts)

Registered Nurse (RN) -Acute Care, Children's Hospital Peds/Adolescence, FT, Variable

Travel Medical-Surgical Orthopedic Registered Nurse - $1,749 per week

Columbia, SC $1,748.00-$1,748.00 1 week ago

Columbia, SC $1,832.80-$1,832.80 1 week ago

Ballentine, SC $68,000.00-$95,000.00 17 hours ago

Registered Nurse (RN) - Nurse Resident, July 2025, Geriatrics / Oncology

Travel Nurse - RN - MS/TELE - Medical Surgical/Telemetry

Columbia, SC $1,785.60-$1,785.60 1 week ago

Columbia, SC $10,000.00-$79,243.00 1 month ago

Columbia, SC $2,240.00-$2,240.00 1 week ago

Registered Nurse (RN) - Nurse Resident, July 2025, Med/Surg

Registered Nurse (RN) - Home Health - $65K-80K per year

Pelion, SC $68,000.00-$95,000.00 5 hours ago

Registered Nurse (RN) - Home Health - $65K-75K per year

Travel Registered Nurse Med Surg / Telemetry

Columbia, SC $1,848.00-$1,848.00 1 week ago

We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.