RN Clinical Quality Assurance Auditor, Chattanooga – Nashville

🔥 1 hour 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

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • 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

• Present and communicate audit results to appropriate parties • Participate in developing procedures and standards supporting quality-of-care goals across lines of business • Schedule and perform facility, practitioner-site, and medical-record reviews using established clinical audit tools • Identify and evaluate exposure areas, potential problems, and liabilities • Analyze clinical data to improve provider compliance through education • Provide oversight for regional contract staff • Coordinate retrieval of HEDIS and/or STARS records • Complete medical-record audits for HEDIS/STARS data collection and quality-of-care reviews • Provide required documents and consulting support for quality and compliance audits • Educate and influence stakeholders to improve audit quality and compliance outcomes • Support compliance standards, Star measure outcomes, and member-care quality

🎯 Requirements

• Registered Nurse (RN) with an active Tennessee license or an active 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 • Bachelor’s Degree in a Health Care related field or equivalent work experience • Demonstrated presentation and team facilitation skills • Proficient in Microsoft Office, including Outlook, Word, Excel, and PowerPoint • Advanced Excel proficiency, including pivot tables, strongly preferred • Excellent oral and written communication skills • Excellent time and project management skills • Strong analytical, planning, organizational, and research skills • Strong critical thinking and nursing leadership experience • Ability to analyze and interpret clinical data, identify trends, and recommend process improvements • Preference for candidates living in Chattanooga or Nashville for occasional provider-office visits • Flexibility to support provider or leadership needs outside standard business hours when required • Various immunizations and/or associated medical tests may be required • Employees routinely operating a vehicle for company business must maintain a valid driver’s license, compliant auto insurance, and an acceptable motor vehicle record

🏖️ Benefits

• Remote work through BCBST’s remote-first organization • Tools and resources needed to succeed • Growth, creativity, and continuous learning support • Potential relocation assistance if residence in Chattanooga is required • Innovation culture and responsible use of AI-enabled tools • Flexible support for changing provider and business needs