Blue Cross and Blue Shield Association - Rancho Cordova, CA
posted 26 days ago
About the position
The Clinical Quality Review (CQR) team is responsible for reviewing potential quality of care issues (PQIs) reported by a member, a member representative, or an internal partner. The Clinical Quality Review (CQR) Nurse Trainer/Auditor will report to the Senior Manager, Clinical Quality Review. In this role you will be responsible for understanding workflows, operational procedures, and Blue Shield of California policies to support the technical, cultural and process changes necessary for the Medicare, Commercial and Medi-Cal lines of businesses (LOBs). This position provides frontline support for nurses and coordinators and works in collaboration with leadership. The CQR Nurse Trainer/Auditor works closely with subject matter experts for each line of business (LOB) to facilitate educational and change management processes for implementation of changes as needed.
Responsibilities
- Review potential quality of care issues (PQIs) reported by members or internal partners.
- Understand workflows and operational procedures related to Medicare, Commercial, and Medi-Cal lines of businesses.
- Support technical, cultural, and process changes necessary for the lines of businesses.
- Provide frontline support for nurses and coordinators.
- Collaborate with leadership to implement changes.
- Work closely with subject matter experts to facilitate educational processes.
Requirements
- Registered Nurse (RN) license required.
- Experience in quality review or auditing in a clinical setting.
- Strong understanding of Medicare, Commercial, and Medi-Cal policies and procedures.
- Excellent communication and collaboration skills.
Nice-to-haves
- Experience in training or educational roles within healthcare.
- Familiarity with change management processes.
- Knowledge of Blue Shield of California policies.
