Healthy Careers Start Here

At Blue Cross & Blue Shield of Mississippi, we encourage professional growth in a challenging and fast-paced atmosphere. Our 'be healthy' culture promotes health and wellness at all levels of the Company, and we provide our employees with the time, tools and resources to commit to a healthy lifestyle.

This position is responsible for researching, documenting, and assisting in developing and implementing value based programs for network providers to include facilities, physicians and ancillary providers.  The Provider Clinical Quality Specialist is responsible for the research and documentation of clinical best practice guidelines, accreditations and related quality measures that align with best practice guidelines and value based reimbursement models such as bundled payment, shared savings, etc.  This position also documents technical specifications related to specific quality measures to be used internals for data reporting and externally for transparency with Network Providers’ data sharing activities.

Job-Specific Requirements:

• Bachelor’s degree in Business-related field, or clinical designation, such as R.N.  A Master’s degree in Healthcare Administration and/or Nursing is preferred.

• At least three years of healthcare administration and/or clinical experience required.  Experience with analyzing and trending healthcare related data preferred.  Experience in the development of provider/hospital quality management programs preferred.

• Must be able to work a flexible schedule when required with frequent travel

• Must have experience with implementing activities for monitoring and/or improving health related outcomes.
• Must have excellent PC skills including experience with Microsoft Word and Excel. Experience with Microsoft Access and Visio is preferred.
• Must be able to work a flexible schedule when required with limited travel.
• Must document and organize work product to demonstrate conformance with departmental, corporate or regulatory requirements.
• Knowledge of accreditation programs such as JCAHO and NCQA
• Knowledge of value based programs such as BPCI and PQRS
• Knowledge of CPT, HCPCS, ICD9, UB Revenue and NDC coding is desired.

Blue Cross & Blue Shield of Mississippi is an Equal opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. We offer a comprehensive benefits package that is worth approximately one-third of the salary compensation. Our benefits program is among the best in the health care field. We are looking for employees who can bring their experience, expertise and dedication to work for our customers.