Healthcare Quality Assurance Professional

3 weeks ago


Long Beach, California, United States Blue Shield of CA Full time

Your Role

The Clinical Quality Review team is responsible for reviewing potential quality of care issues reported by members, representatives, or internal partners. As a Clinical Quality Review Nurse Trainer/Auditor, you will report to the Senior Manager, Clinical Quality Review.

This role requires understanding workflows, operational procedures, and Blue Shield of California policies to support technical, cultural, and process changes necessary for Medicare, Commercial, and Medi-Cal lines of business.

You will provide frontline support for nurses and coordinators, working closely with leadership and subject matter experts to facilitate educational and change management processes.

Responsibilities:

  • Maintain current knowledge of regulatory agencies (DMHC, DHCS, CMS, NCQA) and managed care for various lines of business (HMO, PPO, Medicare, Medi-Cal, Cal Medi-Connect).
  • Develop and implement training programs for nurses and coordinators on quality assurance best practices.
  • Collaborate with cross-functional teams to identify areas for process improvement and develop solutions.
  • Provide feedback to team members and contracted providers on their performance and suggest areas for growth and development.

Requirements:

  • Bachelor's degree or equivalent experience.
  • At least 7 years of prior relevant experience.
  • Current California RN license.
  • 3-5+ years hands-on clinical experience across various specialties and settings.
  • Strong verbal/written communication and organizational skills.
  • Proficient in PC-based software programs, including Microsoft Word, Excel, PowerPoint, and Outlook.

Pay Range: The estimated salary for this role is $129,000 - $154,500 per year in California.



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