RN Clinical Quality Assurance Auditor ( Nashville)

The Supplemental Data Collection team at BCBST is seeking a Clinical Quality Assurance Auditor to support the organization in meeting compliance standards, optimize Star measure outcomes, and enhance the overall quality of member care.

In this role, you will perform quality, compliance, and inter-reviewer audits to identify opportunities for improvement and ensure consistency, accuracy, and adherence to regulatory requirements. You will review and abstract medical records, analyze clinical data, and collaborate with internal stakeholders to support quality initiatives that positively impact Star ratings and member outcomes.

Through effective communication, education, and feedback, you will help drive clinical excellence and promote proper quality of care across the Supplemental Data Collection (SDC) project.

To be successful in this role, in addition to the core job requirements, you'll bring strong critical thinking skills, nursing leadership experience, and the ability to analyze and interpret clinical data. Excellent communication, public speaking, and presentation skills are essential, as this role requires educating and influencing others to improve audit quality and compliance outcomes . Advanced proficiency in Excel, including pivot tables, as well as experience with Word, PowerPoint, and Teams, is strongly preferred .