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 Duties & Responsibilities
Effective 7/22/13: This Position requires an 18 month commitment before posting for other internal positions.
Lead the development and maintenance of the annual QM, UM, and CM documents including:
Job Specific Requirements:
BBEX 10 AEP
Number of Openings Available:
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.