Clinical Quality Management Analyst

E-Verify Program

Clinical Quality Management Analyst evaluating and monitoring staff performance for quality excellence at Blue Cross NC. Providing feedback, support, and guidance to achieve business goals and objectives.

Posted 6/3/2026full-timeDurham • North Carolina • 🇺🇸 United StatesMid-LevelSenior💰 $73,698 - $117,917 per yearWebsite

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

clinical experiencequality auditsdata storytellingHEDIShealthcare quality measureslearning solutions designclinical decision makingworkflow process improvementbenchmarkingtrending

Soft Skills

feedback provisionrelationship-buildingcommunication skillspresentation skillsflexibilitychange facilitationorganizational skillsanalytical skillsteam collaborationproblem-solving

Tools & Technologies

ExcelPowerPoint

Certifications & Qualifications

RNLPN

Industry Keywords

UMCMMedical Reviewquality programsCorporate Medical Policyregulatory requirementsDOIERISANCQAclinical guidelines

About the role

Key responsibilities & impact

Evaluates, analyzes and monitors staff or provider performance to achieve excellence in quality
Provides timely, relevant, accurate, and objective feedback to staff, providers, and the management team which includes a plan of action or recommendations when deficiencies are identified
Acts as technical resource and develops learning solutions that engage the learner and produces desired business goals and objectives
Performs quality audits of staff/providers to ensure compliance with departmental, Plans and regulates policies and procedures
Assists in designing effective learning solutions based on analysis of quality audit results and when quality deficiencies are identified
Monitors and reports on individual and department results to include benchmarking and trending
Acts as a day-to-day resource for technical assistance and clinical decision making
Provides guidance with interpretation of clinical aspects of Corporate Medical Policy and other clinical guidelines to assist in making medical decisions
Aligns clinical decision-making processes with regulatory requirements (e.g. DOI/ERISA/NCQA)
Keeps abreast of medical knowledge, care patterns, regulatory and governmental rules and regulations
Works with management team to support decisions on workflow process, quality improvement, goal setting and data driven information-based decision-making
Provides timely feedback to management on staff/provider performance
Acts to facilitate change efforts and promote department, division and corporate goals

Requirements

What you’ll need

RN with 3 years of clinical experience or LPN with 5 years of clinical experience required
For Behavioral Health specific roles, other applicable licensure may be considered with a minimum of 3 years of clinical experience
Must have previous work experience in applicable business area (i.e. UM, CM, Medical Review or quality programs)
Bachelor's degree or advanced degree preferred
Experience presenting to clinical staff in primary care settings
Knowledge of HEDIS or healthcare quality measures
Strong Excel and PowerPoint proficiency
Ability to translate data into insights (data storytelling)
Strong presentation and communication skills
Relationship-building with provider systems
Flexibility and willingness to travel (25%)

Benefits

Comp & perks

Medical, dental, and vision coverage along with numerous health and wellness programs
Parental leave and support plus adoption and surrogacy assistance
Career development programs and tuition reimbursement for continued education
401k match including an annual company contribution
Work-life balance, flexibility, and the autonomy to do great work