Clinical Quality Reviewer Trainer/Auditor- Nurse, Consultant

Your Role

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.

Your Knowledge and Experience

• Requires a bachelors degree or equivalent experience
• Requires at least 7 years of prior relevant experience
• Requires a current California RN license
• Requires 3-5 plus years hands-on clinical experience across a variety of specialties and settings
• Strong verbal/written communication and organizational skills
• Proficient in use of PC-based software programs including Microsoft Word, Excel, PowerPoint, and Outlook with strong typing skills
• Ability to work independently in a fast-paced and fluid work environment
• Experience with, or strong working knowledge of, regulatory and accreditation agencies (DMHC, DHCS, CMS, NCQA) and managed care for various lines of business (HMO, PPO, Medicare, Medi-Cal, Cal Medi-Connect) preferred.
• Consistent demonstration of knowledge, skills, abilities, and behaviors needed to provide superior and culturally sensitive service to team members, and contracted providers.

Pay Range:

The pay range for this role is: $ 109120.00 to $ 163680.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

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