Clinical Quality Research Analyst

Job Purpose:

This position is responsible for conducting data collection and abstraction of medical records for HEDIS and Quality projects including supplemental data collection. Responsible for interacting with various internal staff, internal departments, and network providers/IPAs to ensure quality performance and results for Blue Cross managed care products. Responsible for auditing all aspects of BCBSIL clinical quality improvement projects and evaluating PCP/MG/IPA compliance with BCBSIL clinical practice guidelines. Also responsible for data analysis, interaction with providers practices and IPAs to educate them on HEDIS measures, gaps in care and quality programs. Translate data into actionable information and determine areas for improvements as well as help implement actions toward improvement and report results to internal and external customers.

Required Job Qualifications:

Registered Nurse (RN) OR licensed clinician with current, unrestricted license in Illinois
Minimum of 3 years' clinical practice experience performing HEDIS medical record review
Minimum of 3 years' Healthcare or Managed Care experience, including quality improvement and/or project management experience
Minimum of 1 year HEDIS medical record data abstraction
Data analysis experience, skills and knowledge of statistical analysis software, and statistical methods and meaning knowledge
Ability to adapt to changing priorities and managing a wide range of quality projects
Able and willing to travel
Verbal and written communication skills
Problem resolution skills and ability to work with difficult situations with respect and diplomacy
Presentation planning and delivery experience for provider training

Preferred Job Qualifications:

Working knowledge of managed care programs and NCQA and/or URAC Accreditation guidelines
Knowledge of quality of care complaints
Project management experience and skills


HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.


Expertise Other Job Type Full-Time Regular Location IL - Chicago

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