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Quality Nurse Navigator, RN/LPN
BlueCross BlueShield of South CarolinaQuality Nurse Navigator monitoring and implementing quality improvement activities for BlueCross BlueShield of South Carolina. Analyzing medical reviews and coordinating accreditation activities in a hybrid role.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in quality management and improvement within clinical or behavioral health settings, with a strong focus on compliance, data analysis, and effective communication. Proficient in managing sensitive information and coordinating accreditation activities.
Highest-signal resume keywords
Quality Management ExperienceHEDIS Data CollectionNCQA Accreditation CoordinationBehavioral Health LicensureMicrosoft Office Proficiency
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Quality Improvement ActivitiesMedical Review AnalysisCorrective Action RecommendationsFormal Documentation PreparationData AnalysisProblem SolvingAnalytical ThinkingBusiness Math Proficiency
Soft Skills
Verbal Communication SkillsWritten Communication SkillsCustomer Service SkillsOrganizational SkillsPresentation Skills
Certifications & Qualifications
Behavioral Health LicensureRegistered Nurse LicensureRegistered Health Information Administrator (RHIA)Licensed Practical Nurse (LPN) Licensure
Industry Keywords
Managed CareCompliance StandardsHealth Plan Employer Data Information Set (HEDIS)National Committee for Quality Assurance (NCQA)
About the role
Key responsibilities & impact- Monitor/implement quality improvement/management activities
- Conduct specific medical reviews as necessary
- Analyze findings and make recommendations for corrective actions
- Prepare formal documentation for compliance with applicable standards/regulations
- Perform Health Plan Employer Data Information Set data collection (HEDIS)
- Coordinate National Committee for Quality Assurance (NCQA) accreditation activities
Requirements
What you’ll need- Associates in a job-related field
- 4 years clinical or behavioral health to include 2 years quality management experience
- Excellent verbal and written communication skills
- Customer service and organizational skills
- Presentation, problem solving, and analytical or critical thinking skills
- Proficient spelling, grammar, punctuation, and basic business math
- Ability to handle confidential or sensitive information with discretion
- Strong understanding of managed care
- Microsoft Office proficiency
- 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), OR, active unrestricted LPN in state of hire
Benefits
Comp & perks- Subsidized health plans
- Dental and vision coverage
- 401k retirement savings plan with company match
- Life Insurance
- Paid Time Off (PTO)
- On-site cafeterias and fitness centers in major locations
- Education Assistance
- Service Recognition
- National discounts to movies, theaters, zoos, theme parks and more