BlueCross BlueShield of South Carolina

Compensation

Full Description

Job Description: • Integrate clinical and medical data with automated technologies to support healthcare operations and informatics • Act as a liaison between clinical expertise, data systems, and regulatory standards to ensure compliance and improve service delivery • Evaluate system performance, validate workflows, and drive process improvements that enhance provider and patient experiences while reducing compliance risk • Submit IT data requests, conduct validity testing, perform quality check processes, manage escalations, contribute to process improvements, and communicate updates to key stakeholders • Analyze prior authorization and code set data to ensure alignment with clinical guidelines, regulatory standards, contracts, and operational requirements • Partner with operations, IT, and vendors to implement and validate clinical decision rules and workflows that support strategic and regulatory objectives • Identify opportunities to enhance automation, reduce provider friction, and improve service turnaround times through collaboration with internal teams and external partners • Monitor data quality and develop reporting tools for leadership and compliance purposes • Translate complex clinical and data insights into actionable strategies • Evaluate system enhancements and participate in testing and validation activities to ensure successful implementation and continuous improvement Requirements: • Bachelors in a job-related field • 7 years’ clinical experience • 3 years’ experience in medical systems coordination/project implementation (concurrent with the 7 years) • Excellent organizational, customer service, verbal and written communication, and analytical or critical thinking skills • Strong problem solving, presentation and project management skills • Good judgment skills • Proficient basic business math • Ability to handle confidential or sensitive information with discretion • Microsoft Office • Advanced knowledge of medical systems support and medical terminology • Active, unrestricted RN licensure from the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC) Benefits: • Subsidized health plans • Dental and vision coverage • 401k retirement savings plan with company match • Life Insurance • Paid Time Off (PTO) • On-site cafeterias and fitness centers in major locations • Education Assistance • Service Recognition • National discounts to movies, theaters, zoos, theme parks and more