Job Description: • This position is responsible for completing the activities outlined in the BCBSLA Quality Management Work plan which includes but not limited to working with internal and external representatives to implement, monitor and revise total quality management initiatives, operational procedures and/or performance standards obtain accreditation and achieve strategic goals. • Analyzes validity of QM data/reports from a clinical perspective. • Support URAC accreditation activities and Quality improvement activities ensuring on-going accreditation for the Organization. • Performs accurate concurrent and retrospective review, as needed to support performance improvement activities in conjunction with the goals and strategic plan. • Assists in performance measurement activities for both providers and the organization (HEDIS, CAHPS and performance measures) at the Plan level, the state level, the arenaflex Association level and/or other national initiatives adopted by the Organization to achieve strategic goals. • Utilizes systematic data collection, aggregation, analysis and reporting techniques to achieve concurrent compliance review of identified quality/patient safety metrics. • Assists the Manager and Department Director and collaborates with the Healthcare Innovations team and analysts to compile reports for internal and external consumption. • Helps quality improvement (QI) manager to plan, design, implement, and maintain quality improvement program(s). • Assists in internal (BCBSLA employees) and external (membership, community, etc) wellness activities to promote prevention and positive health outcomes of our employees and members. This includes but is not limited to Health Fairs and Gaps in Care programs. • Works with all areas of the company to assist in the implementation and expansion of pay for performance programs, which includes but is not limited to network management, provider quality performance and payment methodologies that support the Plan’s corporate goals and maximizes the Plan’s competitive position. • Works with Reimbursement and Network Management departments to support quality measurement goals and provider negotiated contracts with the goal of maintaining a high level of provider satisfaction and impact total arenaflex of care. • Maintain access to applicable data portals and support review of performance data to identify quality improvement opportunities. • Serve as representative on organizational committees, work groups, and special projects that impact activities and functions internally and externally assisting in the design of business solutions and achievement of corporate goals. • Responsible for Organizational service and clinical committees required to meet regulatory guidelines. Reporting on opportunities identified and improvement initiatives proposed or in progress. Provide reports comparing progress with national and/or other benchmarks. May require additional research into quality standards and practices. Pursuit of Lean Six Sigma Green Belt and/or training for Healthcare Quality certification (CPHQ, CPC). Accountable for complying with all laws and regulations and accreditation standards associated with assigned duties and responsibilities. Requirements: • Bachelor's in nursing or business related field is required. • In lieu of Bachelor’s degree an RN license can be used. • In lieu of Bachelor’s degree four years of related experience in healthcare quality can be used. • 4 years of professional nursing practice to include two years of experience in healthcare insurance and/or experience in health care quality required. • Prior experience in organizational assessment (audit) and coordinating efforts to gather data and prepare reports to meet requirements (URAC, NCQA and other regulatory/accrediting agencies) required. • Strongly prefer quality management processes; research, interpretation and/or analysis experience. • Experience working with predictive models and Healthcare Quality metrics (e.g. HEDIS) preferred. • Strong analytical, research, documentation and report skills and ability to analyze QI data and identify trends and corrective actions required. • Excellent oral and written communication, report preparation, and presentation skills to both peer and upper-level management required. • Proficient at utilizing computer programs to effectively collect, analyze, present, and communicate data to the various internal and external stakeholders required. • Experience with interacting effectively with health care team members preferred. • Working knowledge of relevant BCBSLA software systems preferred. • Nursing/RN - Registered Nurse - State Licensure And/Or Compact State Licensure Registered Nurse licensed to practice in the State of Louisiana required. • Lean Six Sigma Green Belt Certification or higher level certification preferred. • Quality certification (CPHQ, CPC) preferred. Benefits: • We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. • Health insurance • Flexible work arrangements • Professional development opportunities Apply tot his job