Clinical Quality Assurance Auditor

🔥 13 hours ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔧 QA Engineer (Quality Assurance)

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BlueCross BlueShield of Tennessee

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1952

⚕️ Healthcare Insurance

Healthcare Insurance

BlueCross BlueShield of Tennessee is a leading health plan provider in Tennessee, serving 3. 4 million members. The company is committed to creating a workforce where everyone is valued, respected, and part of the team, emphasizing diversity and inclusion. They offer a range of career opportunities, including internships through their BlueBridge program, enabling new professionals to transition from college to work. BlueCross BlueShield of Tennessee also focuses on providing exceptional customer service and community care, striving to make a difference in the healthcare industry. It is an independent licensee of the Blue Cross Blue Shield Association and a qualified health plan issuer in the Health Insurance Marketplace.

📋 Description

• Perform quality, compliance, and inter-reviewer audits to identify opportunities for improvement • Review and abstract medical records • Analyze clinical data and collaborate with internal stakeholders • Help drive clinical excellence and promote proper quality of care across the Supplemental Data Collection (SDC) project • Presenting and communicating audit results • Schedule and perform routine facility, practitioner site, and medical record reviews • Analyze clinical data to improve individual provider compliance • Providing required documents and consulting support for quality and compliance audits

🎯 Requirements

• Registered Nurse (RN) with an active Tennessee license or a license from a Nurse Licensure Compact state • 4 years of healthcare experience • 1 year of managed care experience or experience with Quality Medical Record Review • Experience with HEDIS and/or STARS data collection • Strong analytical skills with the ability to identify trends and recommend process improvements • Demonstrated presentation and team facilitation skills • Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)

🏖️ Benefits

• Health insurance • 401(k) matching • Paid time off • Flexible work arrangements • Professional development opportunities