Quality Improvement Coordinator Jobs

We are currently hiring for a Quality Improvement Coordinator to join BlueCross BlueShield of South Carolina. In this role as Quality Improvement 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 performs 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.

• Recommends corrective action and improvement when necessary.
• Performs quality improvement activities to monitor/maintain compliance with applicable standards/regulations.
• Coordinates HEDIS data collection.
• Analyzes/documents/presents findings of quality improvement activities.
• Tracks/trends/investigates quality concerns and complaints.
• Conducts quality medical record reviews to monitor quality of care and service provided.

• 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).
• Microsoft Office.
• 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.
• Demonstrated ability to identify the need for and implement corrective actions.
• Ability to handle confidential OR sensitive information with discretion.
• Four years clinical OR behavioral health to include two years quality management experience.
• Strong understanding of managed care.
• Associate Degree – Nursing OR Master's in Behavioral Health, OR Bachelor's from an accredited HIM program.

• Ability to persuade, negotiate, or influence others.
• Knowledge of mathematical or statistical concepts.

• Continuing education funds for additional certifications and certification renewal.
• Tuition assistance.
• Incentive Plan.
• Nine paid holidays.
• Merit Plan.
• Paid annual leave – the longer you work here, the more you earn.
• 401(k) retirement savings plan with company match.
• Service recognition.
• On-site cafeterias and fitness centers in major locations.
• Subsidized health plans and free vision coverage.
• Wellness programs and healthy lifestyle premium discount.
• Life insurance.