[Hiring] Supervisor, Clinical Quality Assurance @BlueCross BlueShield of Tennessee

Role Description

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.
• Conduct EPSDT reviews for Medicaid, comprehensive medical record reviews for all lines of business, and office site visits for newly credentialed providers.
• 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 skills.
• Ability to effectively manage competing priorities.
• Delivery of measurable results that advance organizational goals.
• Accountability for project outcomes and data quality.
• Strong analytical and problem-solving skills.
• Ability to influence and collaborate across teams.
• Commitment to building team capability while fostering a culture of continuous improvement.
• 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, including using AI-enabled tools responsibly to support everyday work — guided by proven workflows, templates, and policies.

Qualifications

• Bachelors Degree in a Health Related Discipline (Nursing, Dietetics, Exercise Science, Counseling, Social work, or Health Education)
• 2 years - Supervisory experience required
• 5 years - Clinical nursing experience required
• 2 years - Project management experience with demonstrated skills and successes
• Certification as a Professional in Healthcare Quality, HIAA, or equivalent certification
• 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.

Requirements

• 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.

Company Description