Clinical Quality Research Analyst

Leads and coordinates the organization through the accreditation and regulatory audit process; educating and monitoring compliance to the standard across the enterprise

Job Description:

Job 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.

Job Qualifications

License

• 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.

Experience

• 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

Skills\Certifications

• 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 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

Job Specific Requirements: 

Utilization Management experience is a Plus.

BBEX Grade 10 AEP

Preferred Skills:

Number of Openings Available:

1

Worker Type:

Employee

Worker Sub-Type:

Employee

Company:

BCBST BlueCross BlueShield of Tennessee, Inc.

Applying for this job indicates your acknowledgement and understanding of the following statements:

BCBST is an Equal Opportunity employer (EEO), and all employees and applicants will be entitled to equal employment opportunities when employment decisions are made. BCBST will take affirmative action to recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.

Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:

BCBST's EEO Policies/Notices

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

All applicants will be advised that BlueCross, as a federal contractor, may be required to implement a COVID-19 vaccine mandate.

Tobacco-Free Hiring Statement

To further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products (including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and electronic or smokeless cigarettes) in any form in Tennessee and where state law permits. A tobacco or nicotine free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community. All offers of employment will be conting