Integrate quality improvement strategies into the operations of the organization. Coordinate support of the Quality Improvement Program to ensure adherence to relevant evidence-based medicine, wisely accepted best clinical practice, or criteria issued by recognized professional medical societies, accreditation bodies, government agencies, or other nationally recognized healthcare quality organizations.

Job Description:

Job Responsibilities

• Providing coordination and leadership of staff to ensure corporate compliance with accreditation and regulatory standards.
• Providing direction and guidance to staff in the development, implementation, analysis, and evaluation of quality improvement activities designed to promote member health and improve outcomes.
• Lead or coordinate workgroups, meetings, and projects required to ensure and document complex standards compliance.
• Partner with community organizations, vendors, and providers to design and implement health promotion quality improvement activities.
• Using research, experience, and data analysis as tools for identifying existing potential health and service opportunities for improvement and provide recommendations for resolutions of identified problems.
• Serve as educational resource and coordinate the preparation and implementation of quality studies and initiatives, surveys, and audits, as well as coordinate projects within the department.
• Minimum travel is required

Job Qualifications

Education

• Bachelor's Degree in Health Care related field or equivalent work experience

Experience

• 2 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
• 1 year - Experience in management or supervisory/team lead capacity.

Skills\Certifications

• Certification as a Professional in Healthcare Quality or equivalent certification required; or obtained within 1 year after meeting requirements to take the examination.
• Proficient in Microsoft Office (Outlook, Word, Excel and Powerpoint)
• Self-motivated and able to manage multiple tasks and set priorities.
• Excellent oral and written communication skills
• Excellent interpersonal and team building skills
• Proven decision making and problem solving skills
• Strong analytical skills

License

• Registered Nurse (RN) with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law.

Job Specific Requirements: 

Preferred Skills:

Number of Openings Available:

1

Worker Type:

Employee

Company:

BCBST BlueCross BlueShield of Tennessee, 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.

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.