Blue Cross NC · 13 hours ago
Clinical Quality Management Analyst
United States
Full-time
Remote
Mid Level
$74K/yr - $118K/yr
3+ years expBlue Cross and Blue Shield of North Carolina is dedicated to achieving excellence in quality healthcare. They are seeking a Clinical Quality Management Analyst to evaluate and monitor staff performance, provide feedback, and develop learning solutions to meet business goals.
Financial ServicesHealth InsuranceInsurance
Responsibilities
Performs quality audits of staff/providers to ensure compliance with departmental, Plans and regulates policies and procedures
Assists in designing effective learning solutions based on analysis of quality audit results and when quality deficiencies are identified
Monitors and reports on individual and department results to include benchmarking and trending
Acts as a day-to-day resource for technical assistance and clinical decision making
Provides guidance with interpretation of clinical aspects of Corporate Medical Policy and other clinical guidelines to assist in making medical decisions
Aligns clinical decision-making processes with regulatory requirements (e.g. DOI/ERISA/NCQA)
Keeps abreast of medical knowledge, care patterns, regulatory and governmental rules and regulations
Works with management team to support decisions on workflow process, quality improvement, goal setting and data driven information-based decision-making
Provides timely feedback to management on staff/provider performance
Acts to facilitate change efforts and promote department, division and corporate goals
Assist with maintenance of Web Content Management System (WCMS) and may collaborate with other areas to maintain SOP’s
Assists staff with resetting of passwords and set up of new users for vendor electronic messaging
Qualification
Required
RN with 3 years of clinical experience or LPN with 5 years of clinical experience required
Must have previous work experience in applicable business area (i.e. UM, CM, Medical Review or quality programs)
Preferred
Bachelor's degree or advanced degree preferred
Benefits
Medical, dental, and vision coverage along with numerous health and wellness programs
Parental leave and support plus adoption and surrogacy assistance
Career development programs and tuition reimbursement for continued education
401k match including an annual company contribution
Paid Time Off (PTO)
Annual Incentive Bonus
Company
Blue Cross NC
It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way.
5001-10000 employees
H1B Sponsorship
Blue Cross NC has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (4)
2024 (1)
2023 (2)
2022 (5)
2021 (13)
2020 (5)
Funding
Current Stage
Late StageLeadership Team
Tunde Sotunde
President and Chief Executive Officer
Caleb Davies
Medicaid Market CFO - Healthy Blue of NC Medicaid
Recent News
2026-01-06
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