Clinical Quality Research Analyst

We are hiring a Clinical Quality Research Analyst at BCBST.

In this role, you will support healthcare quality improvement efforts by analyzing complex data, conducting accreditation and regulatory audits, and identifying opportunities to strengthen compliance and operational performance. You’ll play a key role in ensuring audit readiness for organizations such as URAC, NCQA, and EQRO while helping drive meaningful improvements that enhance member outcomes and the overall healthcare experience.

You will contribute to organizational success by collaborating with cross‑functional teams, educating stakeholders on quality and compliance standards, and serving as a trusted resource for audit readiness and process improvement initiatives. Additionally, you’ll evaluate trends, identify risks and gaps, and provide actionable recommendations that support sustainable improvements across the enterprise. Your ability to communicate effectively, build strong partnerships, and influence positive change will be essential to success in this role.

To be successful in this position, you’ll bring strong analytical skills, attention to detail, and the ability to thrive in a fast‑paced, collaborative environment. Ideal candidates will have managed care experience and a strong understanding of regulatory and accreditation standards. A current RN license is required. Certifications in healthcare quality or process improvement, such as PAHM, CPHQ, Lean Six Sigma, or CCM, are preferred and will distinguish candidates seeking to expand their impact in quality management.

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 work, improve healthcare quality, and better serve our members.

Note: Remote role within a collaborative and supportive team environment. Schedule: Monday‑Friday 8AM‑5PM EST.

Job Responsibilities

• Perform quality and/or compliance audits to identify and address opportunities for improvement. Coordinate process improvement based on audit results. Provide education and guidance on the development of measures.
• Provide consulting support for quality and compliance audits. Support multidisciplinary workgroups. Use research experience and data analysis to identify potential healthcare and service opportunities for improvement and design solutions.
• Identify existing healthcare and service opportunities for improvement and assist in designing solutions. Educate internal customers on quality processes.
• Present and communicate audit results to appropriate parties; participate in rebuttal processes as applicable. Analyze results for trends and identify areas of non‑compliance.
• This position requires an 18‑month commitment before posting for other internal positions.

Job Qualifications

• Registered Nurse (RN) with an active license in Tennessee or in a state participating in the Nurse Licensure Compact Law.
• Four years of managed care experience, or experience with regulatory or accrediting body requirements (e.g., URAC, NCQA, EQRO, CMS) and clinical quality improvement experience.
• Certification as a Professional in Healthcare Quality, Lean Six Sigma, or equivalent certification required, or must be attained within one year of hire.
• Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.
• Demonstrated presentation and team facilitation skills.
• Proficient in Microsoft Office (Outlook, Word, Excel, PowerPoint).
• Excellent oral and written communication skills.
• Strong analytical skills.

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 under applicable law.

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