Ourhrconnect
Quality Nurse Navigator (RN or LPN)
Columbia, South Carolina · Contract
Sponsorship not specifiedDetected 4 days ago
Customer SupportCommunicationProblem SolvingCritical Thinking
About the role
- Description Location: This position is full-time (40 hours/week) Monday-Friday, from 8:00am - 5:00pm EST and can be hybrid in Columbia, SC or fully remote in South Carolina depending on where the candidate resides.
- 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.
Responsibilities
- 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.
- Demonstrated ability to identify the need for and implement corrective actions.
Requirements
- Required Skills and Abilities: Excellent verbal and written communication, customer service, organizational, presentation, problem solving, and analytical or critical thinking skills.
- Required Software and Other Tools: Microsoft Office.
Nice to have
- Preferred Skills and Abilities: Ability to persuade, negotiate, or influence others.
Skills
- Proficient spelling, grammar, punctuation, and basic business math.
- Ability to handle confidential or sensitive information with discretion.
- Strong understanding of managed care.
- Knowledge of mathematical or statistical concepts.
- Willingness to travel to provider assignments and/or health events.
- Subsidized health plans, dental and vision coverage
- 401k retirement savings plan with company match
- Life Insurance
- Paid Time Off (PTO)
- On-site cafeterias and fitness centers in major locations
- Education Assistance
- Service Recognition
Compensation
- This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.
Benefits
- 4 years clinical or behavioral health to include 2 years quality management experience.
- Conducts quality medical record reviews to monitor quality of care and service provided.
- Required Education: Associates in a job-related field
- Our Comprehensive Benefits Package Includes the Following:
- We offer our employees great benefits and rewards.
- You will be eligible to participate in the benefits the first of the month following 28 days of employment.
Company info
- We are currently hiring for a Quality Nurse Navigator to join BlueCross BlueShield of South Carolina.
Equal opportunity
- 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.
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This listing is sourced directly from Ourhrconnect's careers page and normalized into a canonical job model.