Provider Clinical Quality Specialist
Blue Cross & Blue Shield of Mississippi —Flowood, MS
- Full-time
- Nursing
- Microsoft Excel
- Microsoft Access
- Health insurance
- 401(k)
Specialist, Health Plan Provider Engagement (Remote in MS)
Molina Healthcare —Jackson, MS
- $40,851.44 - $88,511.46 a year
- Full-time
- Remote
- Nursing
- Mid-level
- Analysis skills
- Health insurance
IS Trainer 1 - Jackson, MS
Franciscan Missionaries of Our Lady Health System —Jackson, MS
- Day shift
- Customer service
- Mid-level
- High school diploma or GED
10d
Medical Scribe
Oak Street Health —Jackson, MS
- $17.00 - $25.65 an hour
- Full-time
- Computer literacy
- HIPAA
- Clinic
- Health insurance
- Dental insurance
9d
Field Clinical Specialist: Jackson, MS
BIOTRONIK SE & Co. KG —Jackson, MS
- Weekends as needed
- Nursing
- Clean driving record
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Clinical Documentation Improvement Specialist
The University of Mississippi Medical Center —Jackson, MS
- Full-time
- Microsoft Excel
- Microsoft Outlook
- RN License
Field Clinical Specialist: Jackson, MS
BIOTRONIK —Jackson, MS
- Weekends as needed
- Nursing
- Clean driving record
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Patient Care Specialist (Medical Receptionist)
Fast Pace Health —Ridgeland, MS
- Full-time
- CPR Certification
- Microsoft Outlook
- Computer literacy
- Paid holidays
- Health insurance
MPPS Policy Deviations Senior Manager
CVS Health —Jackson, MS
- $67,900 - $182,549 a year
- Full-time
- Nursing
- 5 years
- Bachelor's degree
- Health insurance
- Dental insurance
Medical Billing Specialist
MDB Health Services —Flowood, MS
- Full-time
- Microsoft Word
- Microsoft Excel
- Customer service
Quick Apply
Medical Coder - Outpatient
The University of Mississippi Medical Center —Jackson, MS
- Full-time
- Mid-level
- High school diploma or GED
- University
4h
Kidney Care Specialist
Fresenius Medical Care —Jackson, MS
- $17 - $30 an hour
- Weekends as needed
- Local
- Mid-level
- High school diploma or GED
5d
Physician Coding Analyst
The University of Mississippi Medical Center —Clinton, MS
- Full-time
- Mid-level
- Office
- High school diploma or GED
Nursing Professional Development Specialist - Nurse Program Coordinator
Franciscan Missionaries of Our Lady Health System —Jackson, MS
- Day shift
- Nursing
- RN License
- BLS Certification
Quick Apply
LPN
Centerwell —Jackson, MS
- $44,000 - $59,600 a year
- Full-time
- Bilingual
- LVN
- Clinic
- Paid parental leave
- Paid holidays
8d
Field Sales Representative- Jackson, MS
Monogram Health Inc —Jackson, MS
- $65,000 - $130,000 a year
- Remote
- High school
- Mid-level
- High school diploma or GED
Quick Apply
Inpatient Coding Auditor
Huron Managed Services LLC —Jackson, MS
- $38.46 - $52.40 an hour
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- Mid-level
- Dental insurance
Quick Apply
5d
Nurse (LPN or RN)
Fast Pace Health —Canton, MS
- Full-time
- CPR Certification
- Nursing
- Vital signs
- Paid holidays
- Health insurance
5d
Endocrinologist
HealthYes Staffing Network —Jackson, MS
- Full-time
- Medicine
- BC/BE
- Internal Medicine
- Relocation assistance
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Emergency Medicine Physician
HealthYes Staffing Network —Jackson, MS
- Full-time
- Medicine
- BC/BE
- ER
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- Paid time off
Quick Apply

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provider clinical quality specialist jobs near flowood, ms

Provider Clinical Quality Specialist

Blue Cross & Blue Shield of Mississippi -
Flowood, MS

Apply Now

Job Details

Full-time

Benefits

Health insurance
On-site gym
401(k)
Paid time off

Qualifications

Microsoft Excel
Presentations for conferences or internal meetings
Research
Bachelor's degree
Productivity software

Full Job Description

Healthy Careers Start Here

Healthy Careers Start Here

At Blue Cross & Blue Shield of Mississippi, we’re not just about providing health insurance, we are creating a strong, supportive community which encourages every Mississippian to live their healthiest life. This mission requires a talented and motivated team with diverse sets of skills and experiences, aligned with the commitment of a healthy Mississippi.

We are seeking a Provider Clinical Quality Specialist to develop, implement, and maintain quality programs as it relates to Women’s Health and Maternal Quality Care. As the driving force of this initiative, this Clinician partners with network providers and hospitals, as well as internal stakeholders to evaluate, structure, implement, and enhance the components of a best practice model value-based program to establish guidelines which support optimal patient care experiences and health outcomes. Once established, this role ensures shared responsibility for outcomes and practices are consistently reviewed for agreement and alignment with best practice measurements and patient care success rates.

This clinical role in a professional setting provides the opportunity to make a state-wide impact on Maternal Care and Women’s Health. A typical day is working with an internal team to analyze data and meet with providers and quality staff to translate complex data into actionable clinical improvements by influencing provider/staff behavior.

Primary responsibilities include:

Research, analysis, and documents clinical best practice guidelines and related quality measures which align with evidence-based best practice guidelines and value-based reimbursement models.
Documents technical specifications related to specific quality measures to be used internally for data reporting and externally for transparency with Network Providers.
Presents actionable data to network providers, sharing current quality performance scores against expectations and identifying opportunities for improvement.
Maintains knowledge of relevant provider quality initiatives and value-based reimbursement models such as Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), Bundled Payment for Care Improvement (BPCI) and Physician Quality Reporting System (PQRS).

This vital role requires the ability to build effective relationships, both internally and externally, excelling in a team environment and respecting professional boundaries. They must be able to present data in an appropriate and actionable manner, confidently advocating for the best practice quality model of care. This Clinician must also embrace the philosophy that the work is more important than the person leading.

This position requires:

Bachelor’s degree in nursing and R.N. licensure that is unrestricted in the state of Mississippi, or advanced practice degree.
Three years’ healthcare clinical experience as a nurse or nurse practitioner.
Skilled in implementing focused activities for monitoring/improving health-related outcomes
Presentation presence that is professionally engaging as well as the ability to explain technical information to a non-technical audience.
Intermediate proficiency utilizing software in the Microsoft Office Suite, specifically Word and Excel
Ability to work a flexible schedule when required with limited or frequent travel.

Preferred include:

Master’s degree in nursing or healthcare administration
Comprehensive understanding of Women’s Health and Obstetrics Care Best Practices.
Intermediate proficiency with Microsoft Access and Visio
Practical knowledge of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), International Classification of Diseases, Tenth Revision (ICD10), Uniform Billing (UB) Revenue and National Drug Code (NDC) coding.
Skilled in data interpretation and statistical analysis for healthcare related trends.
Background in the development of provider/hospital quality management programs.
Solid understanding of value-based programs such as Bundled Payments for Care Improvement (BPCI) and Physician Quality Reporting System (PQRS).
Working knowledge of accreditation programs such as Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and National Committee for Quality Assurance (NCQA).

What to Expect:

A work environment with a focus on your health that allows you to thrive. The walking track, onsite gym and café are just a few of the highlights of the campus. Monthly Team Blue events allow you to meet new people and quickly become a member of the team.

With a highly competitive compensation package that includes medical benefits, 401k, ample paid time off and a schedule that supports true work/life balance, you could continue your career in an organization that is focused on building a healthier Mississippi.

How to Apply and the Process:

Set up a Workday account and complete your application process.
Attach a copy of a resume and cover letter.
Check your email for updates.
Processes may include phone screen, testing, in-person interview (s), skill-based assessments, background and drug testing.

Blue Cross & Blue Shield of Mississippi is an Equal opportunity Employer. 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.

Bring your experience, expertise and dedication to working for our customers.

It’s good to be Blue!

We offer a comprehensive benefits package that is worth approximately one-third of the salary compensation. Our benefits program is among the best in the health care field. We are looking for employees who can bring their experience, expertise and dedication to work for our customers.

Apply Now

Refine Your Search

provider clinical quality specialist jobs in flowood, ms

Provider Clinical Quality Specialist

Specialist, Health Plan Provider Engagement (Remote in MS)

IS Trainer 1 - Jackson, MS

Medical Scribe

Field Clinical Specialist: Jackson, MS

Clinical Documentation Improvement Specialist

Field Clinical Specialist: Jackson, MS

Patient Care Specialist (Medical Receptionist)

MPPS Policy Deviations Senior Manager

Medical Billing Specialist

Medical Coder - Outpatient

Kidney Care Specialist

Physician Coding Analyst

Nursing Professional Development Specialist - Nurse Program Coordinator

LPN

Field Sales Representative- Jackson, MS

Inpatient Coding Auditor

Nurse (LPN or RN)

Endocrinologist

Emergency Medicine Physician

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