Supervisor, Clinical Quallity Assurance

We are hiring a Supervisor for Clinical Quality Assurance here at BCBST to lead a high-performing team of nurses statewide.

In this role, you will guide clinical reviews of medical records, partnering with provider offices to enhance documentation, strengthen patient education, and close gaps in care. Reviews include EPSDT reviews for Medicaid, as well as comprehensive medical record reviews for all lines of business and office site visits for newly credentialed providers. Your team will also play a key role in the annual HEDIS project through hybrid medical record reviews and supplemental data analysis. This is an opportunity to drive meaningful improvements in care quality by collaborating across teams to ensure our members receive the highest standards of service.

The ideal candidate demonstrates strong leadership capability, excellent teaching and communication, effectively managing competing priorities, and delivering measurable results that advance organizational goals. Success in this role requires accountability for project outcomes and data quality, strong analytical and problem-solving skills, the ability to influence and collaborate across teams, and a commitment to building team capability while fostering a culture of continuous improvement and willingness to adapt to evolving roles and processes.

If you are an RN with experience in clinical leadership and a passion for quality improvement, we encourage you to apply and make a lasting impact on healthcare in Tennessee.

Note:

• While this is a remote position, preference will be given to candidates located in Tennessee or a contiguous county.
• Sponsorship is not available for this role.
• We foster a culture where innovation is encouraged. That includes using AI enabled tools responsibly to support everyday work — guided by proven workflows, templates, and policies. As roles become more advanced, we expect employees to leverage AI more broadly to transform how we serve members.

Job Responsibilities

• Maintaining and disseminating documentation and reports pertaining to quality and compliance issues, procedures, processes and methodologies.
• Running database queries and applying logic to analyze complex issues, data, and performance measures.
• Providing coordination and leadership of staff to ensure corporate compliance with accreditation and regulatory standards; lead HEDIS team throughout annual project to meet organizational expected outcomes.
• Staying abreast of changes in accreditation and regulatory requirements for the various areas of the enterprise and takes appropriate action to address these changes.

Job Qualifications

Education

• Bachelors Degree in a Health Related Discipline (Nursing, Dietetics, Exercise Science, Counseling, Social work, or Health Education)

Experience

• 2 years - Supervisory experience required
• 5 years - Clinical nursing experience required
• 2 years - Project management experience with demonstrated skills and successes

Skills\Certifications

• Certification as a Professional in Healthcare Quality, HIAA, or equivalent certification

License

• Registered Nurse (RN) with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law.

N/a

Number of Openings Available

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Applying for this job indicates your acknowledgement and understanding of the following statements:

BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin,citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.

Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:

BCBST's EEO Policies/Notices

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

Originally posted on Himalayas