Clinical Quality Res Analyst

Blue Cross Blue Shield Of Tennessee   •  

Chattanooga, TN

Industry: Business Services


5 - 7 years

Posted 358 days ago

The purpose of this position is to support the BCBST Quality Management Program to ensure compliance to applicable accreditation and regulatory agencies such as: CMS, URAC, the National Committee for Quality Assurance (NCQA), External Quality Review Organizations (EQRO) and BCBSTrequired policies and procedures. Primaryresponsibilities include leading the organization through the accreditation and regulatory process. Educating and monitoring compliance to the standard across the enterprise. This position will focus on quality and process improvements to better facilitate positive patient outcomes. This position will also focus on monitoring and analyzing data for identification of barriers and formulating recommendations to improvehealthcare outcomes. The Quality Research Analyst serves as a resource for entry-level staff and as project leads for department initiatives.

Job Description:

Job Duties & Responsibilities

Effective 7/22/13: This Position requires an 18 month commitment before posting for other internal positions.

  • Maintain extensive knowledge of accrediting body requirements to serve as a QM resource across departments and/or divisions.
  • Serve as an educational resource overseeing preparation and implementation of studies/initiatives, surveys, and audits.

Lead the development and maintenance of the annual QM, UM, and CM documents including:

  • Annual Program Evaluation
  • Program Description
  • Workplan
  • Develop programs, policies & procedures and coordinate projects that support and enhance the overall QM program or departmental efficiencies.
  • Lead coordination and support of communications and logistics functions as designated by management or required for standards compliance.
  • Use research experience and data analytical skills to identify existing potential healthcare and service opportunities for improvement and design solutions for identified problems.
  • Lead and coordinate multi-disciplinary workgroups, sub-committees, teams and any other meetings required to accomplish and document complex standards compliance.
  • Ensure that all projects and departmental activities meet applicable State, Federal, NCQA and URAC requirements. Establish and maintain excellent working relationships throughout the corporation to support department, division and BCBST corporate goals and objectives.
  • Organize and prioritize multiple tasks and deadlines; work independently with limited supervision and complete various projects thoroughly, accurately and timely as assigned by management.
  • Develop and maintain the QM department orientation and training manual.
  • Function as a preceptor for new staff, as well as team leader for assigned initiatives, accomplishing department goals through natural workgroup leadership and coordination.
  • Perform monthly compliance audits

Job Qualifications


  • BS/BA in a health care or quality related degreepreferred.
  • Registered Nurse 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 Lawpreferred
  • Clinical health degree with 5 years health care experiencepreferred


  • Minimum of 5 years managed care experience, or experience with regulatory or accrediting body requirements (i.e., NCQA, URAC, EQRO, CMS) and Clinical Quality Improvement experiencerequired.


  • Certification as a Professional in Healthcare Quality, HIAA, or equivalent certification required, or being actively pursued within 1 year of hire.
  • Strong analytical skills with understanding of basic statisticspreferred.
  • Excellent computer skills with direct experience in MS Office, Word, PowerPoint, and Excel required.
  • Excellent written and oral communication skills (including presentation and team facilitation) required.
  • Ability to work independently or in a team environment

Job Competencies

  • Maintain extensive knowledge of accrediting body requirements to serve as a QM resource across all departments and divisions
  • Use research experience and data analytical skills to identify existing potential healthcare and service opportunities for improvement and design solutions for identified problems.

Job Specific Requirements: 


Case Managementexperiencepreferred

Number of Openings Available:


Worker Type:


Worker Sub-Type:



BCBST BlueCross BlueShield of Tennessee, Inc.

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 membership in a historically under-represented group.

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 in any form in Tennessee and where state law permits. A tobacco-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 tobacco/nicotine test.  An individual whose test result is positive for tobacco/nicotine will be disqualified from employment and the job offer will be withdrawn.  Individuals who fail the tobacco/nicotine screening will be permitted to reapply for employment after 6 months, if tobacco/nicotine-free.