Quality Research Analyst

Facilitate and document standards compliance and the development and implementation of evidence-based quality improvement initiatives and healthcare screening guidelines.

Job Description:

Job Responsibilities

• Coordinate and provide information to support quality improvement studies, initiatives and accreditation reviews.
• Ensure that all projects and departmental activities meet applicable regulatory and/or accrediting requirements.
• Coordinates multidisciplinary workgroups and committees that address and monitor quality activities and identifies noncompliance with standards.
• Coordinating and/or developing the annual documents (work plan, program description, program evaluation).

Job Qualifications

Education

• Bachelor's Degree or equivalent work experience required. Equivalent experience is defined as 4 years of professional work experience in a corporate environment

Experience

• 5 years - Managed care experience, or experience with regulatory or accrediting body requirements (i.e., URAC, NCQA, EQRO, and CMS) and Quality Improvement experience required

Skills\Certifications

• Demonstrated presentation and team facilitation skills
• Proficient in Microsoft Office (Outlook, Word, Excel and Powerpoint)
• Excellent oral and written communication skills
• Ability to manage multiple projects and priorities

Job Specific Requirements: 

The ideal candidate will possess the following preferred qualifications:

• Certified Professional in Healthcare Quality (CPHQ), Certified Case Manager (CCM), Certified Legal Nurse Consultant (CLNC), or Six Sigma Certification (Green Belt or higher) or equivalent certification preferred.

Preferred Skills:

Number of Openings Available:

1

Worker Type:

Employee

Worker Sub-Type:

Employee

Company:

VSHP Volunteer State Health Plan, 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 contingent upon passing a background check which includes an illegal drug and tobacco/nicotine test.  An individual whose post offer screening result is positive for illegal drugs or tobacco/nicotine  and/or whose background check is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six (6) months from the date of the post offer screening results.

Resources to help individuals discontinue the use of tobacco/nicotine products include smokefree.gov or 1-800-QUIT-NOW.