Quality Improvement Nurse Lead

3 weeks ago


Baltimore, Maryland, United States CareFirst BlueCross BlueShield Full time
Key Responsibilities
  • Evaluate clinical quality and procedures within the Clinical Appeals & Grievance Department for Government Programs, ensuring compliance with regulatory standards.
  • Audit clinical appeals and grievance letters/documentation, reporting and analysis to support quality improvement initiatives.
  • Collaborate with other business units, including Utilization Management, Case Management, Claims, Quality Management, and Compliance, to develop and maintain quality standards.

This role requires excellent analytical and problem-solving skills, as well as the ability to communicate effectively with stakeholders. The successful candidate will be able to work independently and as part of a team, with a strong focus on delivering high-quality results.



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