Clinical Quality Improvement Coordinator

At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve.

Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there’s no greater time for forward-thinking professionals like you to join us in delivering on it!

As a member of Team Blue, you’ll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.

The clinical quality improvement coordinator will assist with developing and implementing quality improvement activities, analyzing data, promoting health and wellness initiatives, coordinating collaborative projects to improve health care quality and transparency, investigating quality of care issues and providing internal and external customer support. This position must exceed customer expectations, be cross-functional, and adapt to ever changing corporate and market demands.

As a member of Team Blue, you’ll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.

BCBSNE is happy to offer four work designations for our Omaha area employees: 100% in-office, Hybrid options, and 100% remote.

If choosing to work remote, this role can be located in one of the following states: Florida, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and Texas.

What you’ll do:

• Develop, implement and monitor health care quality programs in collaboration with internal and external stakeholders including network providers to improve quality of care and services for members, improve population health and reduce the cost of care.
• Design, develop, monitor, document and report on clinical quality assessment and improvement activities as required by the Quality Management Program, regulatory and accreditation standards and contract deliverables.
• Contribute to the Quality Management Program activities, Quality Management Committee, quality strategy and work plan, and related reporting within defined deadlines. Complete special projects as assigned.
• Investigate, monitor, document and report on quality of care and service issues regarding health care and services rendered within the BCBSNE provider networks.
• Communicate with internal and external stakeholders at all levels, both verbally and in writing, regarding quality of care, service issues, and quality improvement initiatives.
• Promote a culture of preventive health and wellness both in and out of BCBSNE through support of wellness program initiatives.

To be considered for this position, you must have:

• Bachelor’s degree in nursing, health information management, or related health care field

• Two or more (2+) years experience in health care quality and performance improvement, patient safety, risk management, utilization management, case management or health data analysis in a health care organization or health plan.

An equivalent combination of education and experience may be substituted for this requirement.

The ability to meet or exceed the attendance and timeliness requirements of their departments.

The ability to work well in a team environment and be capable of building and maintaining positive relationships with other staff, departments, and customers.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and or ability required.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties may be assigned.

The strongest candidates for this position will also possess:

• One or more (1+) years Health Plan/HEDIS/STARS experience and/or knowledge

• Experience and/or knowledge of Medicare Advantage

• Experience leading teams or individuals for better quality outcomes

• Certified Professional in Health Care Quality (CPHQ)

• Master’s Degree in a healthcare related field

Learn more about what makes BCBSNE such an exceptional place to work by visiting NebraskaBlue.com/Careers.

We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.

Blue Cross and Blue Shield of Nebraska is an Equal Opportunity /Affirmative Action Employer - Minorities/Females/Disabled/Veterans