Quality Nurse Navigator
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Job Location:
Columbia, IN - USA
Monthly Salary:
Not Disclosed
Posted on:
30+ days ago
Vacancies:
1 Vacancy
Job Summary
Summary
We are currently hiring for a Quality Nurse Navigator to join BlueCross BlueShield of South 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 correcctive 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 activites.
Description
Location
This position is full-time (40 hours/week) Monday-Friday from 8:00am-5:00pm EST and will be hybrid.
What Youll 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 Youll Need the Following:
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.
We Prefer That You Have the Following:
- Preferred Work Experience: Prior knowledge or work experience with HEDIS
- Ability to persuade negotiate or influence others. Knowledge of mathematical or statistical concepts.
Our Comprehensive Benefits Package Includes the Following:
We offer our employees great benefits and rewards. You will be eligible to participate in the benefits for the first of the month following 28 days of employment.
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
What We Can Do for You:
We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills advance their careers and contribute their unique abilities to the growth of our company.
What To Expect Next:
After 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 our recruiter to verify resume specifics and salary will conduct interviews with those candidates who qualify with prioritization given to those candidates who demonstrate the preferred qualifications.
Equal Employment Opportunity Statement
BlueCross 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 individuals with disabilitiesand protected 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 disabilities pregnant individuals individuals with pregnancy-related conditions and individuals needing accommodations for sincerely held religious beliefs provided that those accommodations do not impose an undue hardship on the Company.
If you need special assistance or an accommodation while seeking employment please email or call 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.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Heres moreinformation.
Some states have required notifications. Heres more information.
Key Skills
- EMR Systems
- Hospital Experience
- Acute Care
- ICU Experience
- Dermal Fillers
- Experience Administering Injections
- Home Care
- Nursing
- Botox Experience
- Critical Care Experience
- Medication Administration
- Tube Feeding
About Company
You can’t reach new heights of performance unless you’re willing to invest in others. That people-first mantra has been our guiding light since we started in the Medicare business in 1965. Headquartered in Columbia, S.C., and with offices in Augusta, Ga.; Birmingham, Ala.; Camden, S.C ... View more
