Note: The job is a remote job and is open to candidates in USA. BlueCross BlueShield of Tennessee is hiring a Clinical Quality Research Analyst to support healthcare quality improvement efforts. The role involves analyzing complex data, conducting audits, and collaborating with teams to enhance compliance and operational performance.
Responsibilities
- Performs quality and/or compliance audits to identify and address opportunities for improvement. Coordinates Process Improvement based upon audit results. Provides education and guidance on development of measures
- Providing consulting support for quality and compliance audits. Provides support for multidisciplinary workgroups. Using research experience and data analysis as tools for identifying existing potential healthcare and service opportunities for improvement and can design solutions for identified problems
- Identifying existing potential healthcare and service opportunities for improvement and assist in designing solutions for identified problems. Educates internal customers on Quality Processes
- Presenting and communicating audit results to appropriate parties; participating in rebuttal processes as applicable. Analyzes results for trends and identifies areas of non-compliance
- This Position requires an 18 month commitment before posting for other internal positions
Skills
- Registered Nurse (RN) with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law
- 4 years - Managed care experience, or experience with regulatory or accrediting body requirements (i.e., URAC, NCQA, EQRO, and CMS) and Clinical Quality Improvement experience required
- Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability
- Demonstrated presentation and team facilitation skills
- Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
- Excellent oral and written communication skills
- Strong analytical skills
- Certification as a Professional in Healthcare Quality
- Lean Six Sigma Certification
- Equivalent certification
Benefits
- This is a remote role within a collaborative and supportive team environment
- Schedule: Monday-Friday 8AM-5PM EST
Company Overview