Quality Management Coordinator RN

You likely know us as an insurance company, but that’s just a portion of what we do. Hundreds of thousands of North Dakotans trust us to provide them with personalized service and unmatched access to care. It’s a mission we take seriously. We also work with entities throughout the state to challenge the cost and complexity of health care in North Dakota. This uncompromising goal requires caring, innovative people who are ready and willing to help create a new level of health and well-being in North Dakota and beyond.

Although this role supports remote, hybrid, or in‑office work, if the selected candidate chooses a remote arrangement, they must reside within approximately 300 miles of Fargo, ND, to allow for periodic travel as needed. We empower our employees to find a work style that is best for them. Learn more at Life at Blue | BCBSND. This position is eligible for internal Blue Cross Blue Shield employees and external applications. The Quality Management Coordinator (Registered Nurse) is responsible for supporting the overall functions of the Quality Management Program, ensuring the program’s activities are following state and federal regulations and all other recognized quality standards. Additionally, this position provides support, coordination, and facilitation of quality measures to participating providers.

Supports Quality Management Program to ensure the effectiveness of the program. Identifies performance measures for the program’s activities, tracks performance against these measures and develops an action plan(s) to address issues. Supports the development, implementation and annual review of policies and procedures. Coordinates reporting of quality management activities to the various committees and Department of Insurance (DOI). Oversees annual collection, analysis and reporting of health care information to fulfill quality measures reporting requirements. Partners with internal departments, vendors, and auditors. Supports management of the accreditation and reaccreditation process, assures desktop submission requirements and timelines are met, facilitates onsite validation reviews, and educates staff on accreditation process and standards. Coordinates the activities for quality programs. Participates in scheduled group conference calls, provides program information to eligible providers, assists providers with application and submission and provides notification regarding designations. Reports program updates to internal committees and staff as appropriate. Serves as a resource and participates in appropriate special projects, audits or other activities as requested. Provides support, education and coaching to participating providers in meeting specific quality measures by facilitating conference calls and on-site visits. Partners with internal and external stakeholders to understand data needs and delivery of insightful solutions.