Job Overview
Location
USA, TN, Chattanooga, Remote
Job Type
Full-time
Category
Other
Date Posted
May 27, 2026
Full Job Description
đź“‹ Description
- • Lead a statewide team of nurses in conducting clinical quality assurance reviews of medical records across all lines of business.
- • Oversee EPSDT reviews for Medicaid members and comprehensive medical record reviews for newly credentialed providers through office site visits.
- • Direct the annual HEDIS project by coordinating hybrid medical record reviews and supplemental data analysis to meet organizational performance targets.
- • Ensure corporate compliance with accreditation and regulatory standards by maintaining and disseminating documentation, reports, procedures, and methodologies related to quality assurance.
- • Run database queries and apply analytical logic to evaluate complex clinical data, performance measures, and compliance gaps.
- • Partner with provider offices to improve clinical documentation, enhance patient education, and close care gaps that impact member outcomes.
- • Stay current with evolving accreditation, regulatory, and industry standards, and implement necessary adjustments to team processes and workflows.
- • Foster a culture of continuous improvement by mentoring team members, building clinical capability, and promoting accountability for project outcomes and data integrity.
- • Leverage AI-enabled tools responsibly, guided by established workflows and policies, to support and enhance daily quality assurance tasks.
- • Collaborate cross-functionally with internal teams to ensure members receive the highest standard of care and service aligned with organizational goals.
- • Manage competing priorities effectively while delivering measurable results that advance clinical quality and operational efficiency.
- • Demonstrate strong leadership through clear communication, teaching, and influence to drive team performance and organizational success.
- • Maintain active oversight of team productivity, compliance adherence, and project timelines to ensure timely and accurate reporting.
- • Support the organization’s commitment to innovation by adapting to evolving roles, processes, and technology in clinical quality assurance.
🎯 Requirements
- • Registered Nurse (RN) with active license in Tennessee or a Nurse Licensure Compact state
- • 5 years of clinical nursing experience
- • 2 years of supervisory experience
- • 2 years of project management experience with demonstrated successes
- • Bachelor’s degree in a health-related discipline (e.g., Nursing, Dietetics, Exercise Science, Counseling, Social Work, or Health Education)
- • Certification as a Professional in Healthcare Quality, HIAA, or equivalent
🏖️ Benefits
- • Remote work flexibility with preference given to candidates in Tennessee or contiguous counties
- • Opportunity to lead impactful clinical quality initiatives that improve member care statewide
- • Use of AI-enabled tools to enhance efficiency and transform quality assurance workflows
- • Culture that encourages innovation, continuous improvement, and professional growth
Skills & Technologies
About BlueCross BlueShield of Tennessee
BlueCross BlueShield of Tennessee is the largest health-benefit plan company headquartered in the state, providing medical, dental, vision, and Medicare Advantage coverage to individuals, employers, and government programs. Founded in 1945 as a nonprofit mutual insurance company, it administers benefits for more than 3 million members through statewide provider networks, care-management programs, and digital health services. The company also engages in community health initiatives, preventive-care outreach, and value-based reimbursement models to improve outcomes and manage costs across Tennessee.
Subscribe to the weekly newsletter for similar remote roles and curated hiring updates.
Newsletter
Weekly remote jobs and featured talent.
No spam. Only curated remote roles and product updates. You can unsubscribe anytime.
