Quality Review and Improvement Nurse

3 days ago


Baltimore, Maryland, United States CareFirst BlueCross BlueShield Full time
About the Role

CareFirst BlueCross BlueShield is seeking a seasoned Clinical Quality Assurance Specialist to join our team in the Government Programs Appeals Department. As a key member of our quality review team, you will be responsible for evaluating clinical quality and procedures within our department, ensuring compliance with regulatory standards.

The ideal candidate will have significant clinical nursing experience, with a strong background in quality auditing and improvement. A Master's degree in nursing is preferred, and experience with government programs, utilization management, and managed care is highly valued.

Key Responsibilities
  • Evaluate clinical quality and procedures within the Government Programs Appeals Department
  • Develop and implement systematic audit tools to measure compliance
  • Collaborate with training teams to develop resources for appeals and grievance education
  • Trend results of clinical reviews and present findings to stakeholders
Benefits and Compensation

We offer a competitive salary range of $75,888 - $150,722, based on experience. In addition to our comprehensive benefits package, including medical, dental, and vision insurance, and a 401(k) plan with company match, you will have opportunities for professional growth and development.



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