SummaryWe are currently hiring for a Quality Improvement Coordinator to join BlueCross BlueShield of South Carolina. In this role as Quality Improvement Coordinator, you will monitor/implement quality improvement/management activities. You will conduct specific medical reviews as necessary, analyze findings, make recommendations for corrective actions, and prepare formal documentation for compliance with applicable standards/regulations. You will also perform Health Plan Employer Data Information Set data collection (HEDIS), and National Committee for Quality Assurance (NCQA) accreditation activities.Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we've been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina ... and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future.
DescriptionLogisticsThis position is full time (40 hours/week) Monday-Friday and will have a
flexible work arrangement to be onsite at 17 Technology Circle, Columbia, S.C., 29203 (as needed) and remote (W@H).What You Will Do:- 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 Will Need:- Associates in a job-related field.
- Four years clinical OR behavioral health to include two-years quality management experience.
- 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.
- Microsoft Office.
- 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).
What We Prefer:- Ability to persuade, negotiate, OR influence others.
- Knowledge of mathematical OR statistical concepts.
- Ability to be proactive.
- Reside OR willing to travel to Upstate Greenville OR Myrtle Beach area.
- Medicare/Quality/HEDIS experience.
What We Can Do for You- 401(k) retirement savings plan with company match.
- Subsidized health plans and free vision coverage.
- Life insurance.
- Paid annual leave - the longer you work here, the more you earn.
- Nine paid holidays.
- On-site cafeterias and fitness centers in major locations.
- Wellness programs and healthy lifestyle premium discount.
- Tuition assistance.
- Service recognition.
- Incentive Plan.
- Merit Plan.
- Continuing education funds for additional certifications and certification renewal.
What to Expect NextAfter 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 a recruiter to verify resume specifics and salary requirements.Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Some states have required notifications. Here's more information. Equal Employment Opportunity StatementBlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.If you need special assistance or an accommodation while seeking employment, please e-mail ...@bcbssc.com or call 1-800-###-####, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.