Remote Optum Rn Jobs in Cleveland, TN (NOW HIRING)

We are hiring a Clinical Quality Research Analyst at BCBST!

In this role, you will support healthcare quality improvement efforts by analyzing complex data, conducting accreditation and regulatory audits, and identifying opportunities to strengthen compliance and operational performance. You'll play a key role in ensuring audit readiness for organizations such as URAC, NCQA, and EQRO while helping drive meaningful improvements that enhance member outcomes and the overall healthcare experience.

You will contribute to organizational success by collaborating with cross-functional teams, educating stakeholders on quality and compliance standards, and serving as a trusted resource for audit readiness and process improvement initiatives. Additionally, you'll evaluate trends, identify risks and gaps, and provide actionable recommendations that support sustainable improvements across the enterprise. Your ability to communicate effectively, build strong partnerships, and influence positive change will be essential to success in this role.

To be successful in this position, you'll bring strong analytical skills, attention to detail, and the ability to thrive in a fast-paced, collaborative environment. Ideal candidates will have managed care experience and a strong understanding of regulatory and accreditation standards. A current RN license is required. Certifications in healthcare quality or process improvement, such as PAHM, CPHQ, Lean Six Sigma, or CCM, are preferred and will distinguish candidates seeking to expand their impact in quality management.

We foster a culture where innovation is encouraged. That includes using AI-enabled tools responsibly to support everyday work-guided by proven workflows, templates, and policies. As roles become more advanced, we expect employees to leverage AI more broadly to transform how we work, improve healthcare quality, and better serve our members.

Note:

• This is a remote role within a collaborative and supportive team environment
• Schedule: Monday-Friday 8AM-5PM EST

Job Responsibilities

• Performs quality and/or compliance audits to identify and address opportunities for improvement. Coordinates Process Improvement based upon audit results. Provides education and guidance on development of measures.
• Providing consulting support for quality and compliance audits. Provides support for multidisciplinary workgroups. Using 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 problems. Educates internal customers on Quality Processes.
• Presenting and communicating audit results to appropriate parties; participating in rebuttal processes as applicable. Analyzes results for trends and identifies areas of non-compliance.
• This Position requires an 18 month commitment before posting for other internal positions.

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

Skills\Certifications

• Certification as a Professional in Healthcare Quality, Lean Six Sigma Certification, or equivalent certification required, or must be attained 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

This position is a BBEX, Grade 10, Incentive AEP

Number of Openings Available

1

Worker Type:

Employee

Company:

BCBST BlueCross BlueShield of Tennessee, Inc.

Applying for this job indicates your acknowledgement and understanding of the following statements:

BCBST will 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 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.