Quality Nurse Navigator (RN or LPN)

About the role

We are currently hiring for a Quality Nurse Navigator to join BlueCross BlueShield of South Carolina. In this role as a Quality Nurse Navigator, you will monitor/implement quality improvement/management activities, conduct specific medical reviews as necessary, analyze findings, make recommendations for corrective actions, and prepare formal documentation for compliance with applicable standards/regulations, and perform Health Plan Employer Data Information Set data collection (HEDIS), and National Committee for Quality Assurance (NCQA) accreditation activities. Location: This position is full-time (40 hours/week) Monday-Friday, from 8:00am - 5:00pm EST and can be hybrid in Columbia, SC or fully remote in South Carolina depending on where the candidate resides. The candidate will be required to report on-site occasionally for trainings, meetings, or other business needs.

Responsibilities

• Performs quality improvement activities to monitor/maintain compliance with applicable standards/regulations.
• Analyzes/documents/presents findings of quality improvement activities. Recommends corrective action and improvement when necessary.
• Conducts quality medical record reviews to monitor quality of care and service provided. Tracks/trends/investigates quality concerns and complaints.
• Coordinates HEDIS data collection.
• To Qualify for This Position, You'll Need the Following:
• Required Education: Associates in a job-related field
• Required Work Experience: 4 years clinical or behavioral health to include 2 years quality management experience.
• Required Skills and Abilities: 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.
• Ability to handle confidential or sensitive information with discretion.
• Demonstrated ability to identify the need for and implement corrective actions.
• Strong understanding of managed care .
• Required Software and Other Tools: Microsoft Office.
• What We Prefer You to Have:
• Preferred Skills and Abilities: Ability to persuade, negotiate, or influence others.
• Knowledge of mathematical or statistical concepts.
• Willingness to travel to provider assignments and/or health events.
• Our Comprehensive Benefits Package Includes the Following:
• We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.
• 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
• What We Can Do for You:
• We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.
• What To Expect Next:
• After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.
• Equal Employment Opportunity Statement
• If you need special assistance or an accommodation

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