Clinical Quality Research Analyst

BCBST BlueCross BlueShield of Tennessee, Inc. - Chattanooga, TN

Full-time

Remote - Chattanooga, TN

About the position

The position involves performing quality and compliance audits to identify areas for improvement within healthcare services. The role requires coordination of process improvements based on audit findings, providing education on quality measures, and supporting multidisciplinary workgroups. The individual will utilize research and data analysis to identify healthcare opportunities and design solutions, while also educating internal customers on quality processes and presenting audit results to relevant parties.

Responsibilities

• Perform quality and/or compliance audits to identify and address opportunities for improvement.
• Coordinate process improvement based on audit results.
• Provide education and guidance on the development of measures.
• Offer consulting support for quality and compliance audits.
• Support multidisciplinary workgroups.
• Use research experience and data analysis to identify healthcare and service opportunities for improvement and design solutions for identified problems.
• Educate internal customers on quality processes.
• Present and communicate audit results to appropriate parties; participate in rebuttal processes as applicable.
• Analyze results for trends and identify areas of non-compliance.

Requirements

• Registered Nurse (RN) with an active license in Tennessee or a participating state in the Nurse Licensure Compact Law.
• 4 years of managed care experience or experience with regulatory/accrediting body requirements (e.g., URAC, NCQA, EQRO, CMS) and clinical quality improvement experience required.
• Certification as a Professional in Healthcare Quality, Lean Six Sigma Certification, or equivalent certification required, or must be attained within 1 year of hire.
• Ability to work independently with minimal supervision or in a team environment sharing responsibility, roles, and accountability.
• Demonstrated presentation and team facilitation skills.
• Proficient in Microsoft Office (Outlook, Word, Excel, PowerPoint).
• Excellent oral and written communication skills.
• Strong analytical skills.

Nice-to-haves

• Audit Survey Accreditation
• Proficient with Adobe
• Familiarity with the External Survey Process
• Data Analysis

Benefits

• Remote work options
• Relocation benefits for applicants moving to Chattanooga, TN