Bcbsnc
Clinical Quality Management Analyst
Hybrid Flex - Durham
Sponsorship not specified$74k-$118kDetected 26 days ago
ExcelClinical TrialsClinical ResearchResearchCommunicationCollaborationPublic SpeakingMicrosoft Office
About the role
- Job Description Evaluates, analyzes and monitors staff or provider performance to achieve excellence in quality.
- Provides timely, relevant, accurate, and objective feedback to staff, providers, and the management team which includes a plan of action or recommendations when deficiencies are identified.
- Assists in designing effective learning solutions based on analysis of quality audit results and when quality deficiencies are identified.
Responsibilities
- Works with management team to support decisions on workflow process, quality improvement, goal setting and data driven information-based decision-making.
- Performs quality audits of staff/providers to ensure compliance with departmental, Plans and regulates policies and procedures.
- Relationship-building with provider systems
Requirements
- RN with 3 years of clinical experience or LPN with 5 years of clinical experience required.
- Strong Excel and PowerPoint proficiency
Nice to have
- Bachelor's degree or advanced degree preferred.
Skills
- Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants.
- All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC.
- Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com.
Compensation
- At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed.
- Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs.
- Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.
- Based on annual corporate goal achievement and individual performance.
- $73,698.00 - $117,917.00
- 401k match including an annual company contribution
Benefits
- Provides guidance with interpretation of clinical aspects of Corporate Medical Policy and other clinical guidelines to assist in making medical decisions.
- Keeps abreast of medical knowledge, care patterns, regulatory and governmental rules and regulations.
- For Behavioral Health specific roles, other applicable licensure may be considered with a minimum of 3 years of clinical experience.
- Must have previous work experience in applicable business area (i.e. UM, CM, Medical Review or quality programs).
- Knowledge of HEDIS or healthcare quality measures
- The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community
- Medical, dental, and vision coverage along with numerous health and wellness programs
- Parental leave and support plus adoption and surrogacy assistance
- Career development programs and tuition reimbursement for continued education
- Our Hybrid Flex approach is built on presence with a purpose - giving you flexibility to work remotely with intentional in-person connection - that supports a workplace that's flexible, connected, and future focused.
This listing is sourced directly from Bcbsnc's careers page and normalized into a canonical job model.