About the position 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. Description Location: This position is full-time (40 hours/week) Monday-Friday, from 8:00am – 5:00pm EST and will be hybrid at our Government Programs Complex building in Columbia, SC.

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.

Requirements

• 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.
• Required Licenses and Certificates: 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), OR, active unrestricted LPN in state of hire.

Nice-to-haves

• Preferred Skills and Abilities: Prior knowledge or experience working with HEDIS
• Ability to persuade, negotiate, or influence others.
• Knowledge of mathematical or statistical concepts.

Benefits

• 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