Summary
 

We are currently hiring for a RN Quality Improvement Policy Coordinator to join BlueCross BlueShield of South Carolina. In this role as RN Quality Improvement Policy Coordinator, you will monitor/implement quality improvement/management activities. You will conduct specific medical reviews as necessary, analyze findings, make recommendations for corrective actions, and prepare formal documentation for compliance with applicable standards/regulations. You will also perform Health Plan Employer Data Information Set data collection (HEDIS), and National Committee for Quality Assurance (NCQA) accreditation activities.

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future.

Description
 

Logistics

This position is full time (40 hours/week) Monday-Friday and be fully remote (W@H) with the possibility to work onsite at 17 Technology Circle, Columbia, S.C., 29203.

What You’ll Do:

• Performs quality improvement activities to monitor/maintain compliance with applicable standards/regulations.

• Analyzes/documents/presents findings of quality improvement activities.

• Recommends corrective action and improvement when necessary.

• Conducts quality medical record reviews to monitor quality of care and service provided.

• Tracks/trends/investigates quality concerns and complaints.

• Coordinates HEDIS data collection.

To Qualify for This Position, You’ll Need the Following:

• Associates in a job-related field.

• Four years clinical OR Behavioral Health to include two-years Quality Management experience.

• Excellent verbal and written communication, customer service, organizational, presentation, problem solving, and analytical OR critical thinking skills.

• Proficient spelling, grammar, punctuation, and basic business math.

• Ability to handle confidential OR sensitive information with discretion.

• Demonstrated ability to identify the need for and implement corrective actions.

• Strong understanding of managed care.

• Microsoft Office.

• Active, unrestricted licensure in Behavioral Health from the United States and in the state of hire, OR active, unrestricted RN licensure from the United States and in the state of hire, OR active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC), OR Registered Health Information Administrator (RHIA).

We Prefer That You Have the Following:

• Ability to persuade, negotiate, OR influence others.

• Knowledge of mathematical OR statistical concepts.