Job details
Job type full-time
Full job description
Please note: this position is remote with some geographic restrictionsTo be hired for this position, you must live in one of the following states:
Tennessee (tn), georgia (ga), alabama (al), mississippi (ms), arkansas (ar).
Leads and coordinates the organization through the accreditation and regulatory audit process; educating and monitoring compliance to the standard across the enterprise
Job description:
Job responsibilities
Performs quality and/or compliance audits to identify and address opportunities for improvementCoordinates process improvement based upon audit resultsProvides education and guidance on development of measures.
Providing consulting support for quality and compliance auditsProvides support for multidisciplinary workgroupsUsing research experience and data analysis as tools for identifying existing potential healthcare and service opportunities for improvement and can design solutions for identified problems.
Identifying existing potential healthcare and service opportunities for improvement and assist in designing solutions for identified problemsEducates internal customers on quality processes.
Presenting and communicating audit results to appropriate parties; participating in rebuttal processes as applicableAnalyzes results for trends and identifies areas of non-compliance.
This position requires an 18 month commitment before posting for other internal positions.
Various immunizations &/or associated medical tests may be required for this position.
Job qualifications
License
Registered nurse (rn) 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 law.
Experience
4 years - managed care experience, or experience with regulatory or accrediting body requirements (i.e., urac, ncqa, eqro, and cms) and clinical quality improvement experience required
Skillscertifications
Certification as a professional in healthcare quality, lean six sigma certification, or equivalent certification required, or being actively pursued within 1 year of hire.
Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.
Demonstrated presentation and team facilitation skills
Proficient in microsoft office (outlook, word, excel and powerpoint)
Excellent oral and written communication skills
Strong analytical skills
Job specific requirements:
Utilization management experience is a plus
Preferred skills:
Number of openings available:
1
Worker type:
Employee
Worker sub-type:
Flexhome
Company:
Bcbst bluecross blueshield of tennessee, inc.
Applying for this job indicates your acknowledgement and understanding of the following statement:
Bcbst is an equal opportunity employer (eeo), and all employees and applicants will be entitled to equal employment opportunities when employment decisions are madeBcbst 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 any other characteristic protected by applicable law.
Further information regarding bcbst`s eeo policies/notices may be found by reviewing the following page:
Bcbst`s eeo policies/notices
Bluecross blueshield of tennessee is not accepting unsolicited assistance from search firms for this employment opportunityAll 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 consideredNo 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
T o 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 (including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and electronic or smokeless cigarettes) in any form in tennessee and where state law permitsA tobacco or nicotine 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 communityAll offers of employment will be contingent upon passing a background check which includes an illegal drug and tobacco/nicotine testAn individual whose post offer screening result is positive for illegal drugs or tobacco/nicotine and/or whose background check is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six (6) months from the date of the post offer screening results.
Resources to help individuals discontinue the use of tobacco/nicotine products include smokefree.gov or 1-800-quit-now.
