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Clinical Quality Research Analyst Ltss

Company

BlueCross BlueShield of Tennessee
Address , Chattanooga, 37402, Tn
Employment type FULL_TIME
Salary
Expires 2023-06-16
Posted at 1 year ago
Job Description
Facilitate and document standards compliance and the development and implementation of evidence-based clinical quality improvement initiatives
:
BlueCross, as a federal contractor, may be required to implement a COVID-19 vaccine mandate.
Job Responsibilities
  • Coordinate and provide information to support quality improvement studies, initiatives and accreditation reviews.
  • Identifying existing potential healthcare and service opportunities for improvement and assist in designing solutions for identified problems. Ensure that all projects and departmental activities meet applicable regulatory and/or accrediting requirements. Educates internal customers on Quality Processes.
  • Coordinates multidisciplinary workgroups and committees that address and monitor quality activities and identifies noncompliance with standards. Using research experience and data analysis as tools for identifying existing potential healthcare and service opportunities for improvement and can design solutions for identified problems.
  • Performs quality and/or compliance audits to identify and address opportunities for improvement. Coordinates Process Improvement based upon audit results. Provides education and guidance on development of measures.
Job Qualifications
Education
  • Bachelor’s Degree in a health care or quality related field.
Experience
  • 5 years - Managed care experience, or experience with regulatory or accrediting body requirements (i.e., URAC, NCQA, EQRO, and CMS) and Clinical Quality Improvement experience required
Skills\Certifications
  • Certified Professional in Healthcare Quality (CPHQ), Certified Case Manager (CCM), Certified Legal Nurse Consultant (CLNC), or Six Sigma Certification (Green Belt or higher) preferred.
  • Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
  • Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.
  • Demonstrated presentation and team facilitation skills
  • Excellent oral and written communication skills

Job Specific Requirements:
Employees who are required to operate either a BCBST-owned vehicle or a personal or rental vehicle for company business on a routine basis* will be automatically enrolled into the BCBST Driver Safety Program. The employee will also be required to adhere to the guidelines set forth through the program. This includes, maintaining a valid driver’s license, auto insurance compliance with minimum liability requirements; as defined in the “Use of Non BCBST-Owned Vehicle” Policy (for employees driving personal or rental vehicles only); and maintaining an acceptable motor vehicle record (MVR). *The definition for "routine basis" is defined as daily, weekly or at regularly schedule times.
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.