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Health Care Service CorporationPosted 10/19/2026full-timeRemote • Tennessee • United StatesMid-LevelSenior💰 $69,800 - $125,900 per yearWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in quality improvement and quality management activities, with a strong focus on evaluating clinical performance and conducting thorough investigations of quality of care issues. Proficient in maintaining confidentiality and presenting actionable solutions to enhance quality outcomes and member experience.
Highest-signal resume keywords
Registered Nurse (RN) LicenseQuality ImprovementClinical Performance AssessmentHealthcare Processes KnowledgeAnalytical and Problem-Solving Skills
About the role
Key responsibilities & impact- Conduct reviews and investigations of potential quality of care issues in a timely and efficient manner
- Conduct quality improvement and quality management activities in accordance with state and federal regulatory requirements
- Evaluate medical records for appropriateness of care
- Assess the clinical performance of physicians and other health professionals
- Maintain confidentiality of sensitive documents, records, discussions, and information
- Keep the QOC Manager updated on activities, identified issues, and actions to address issues
- Identify trends, develop recommendations, and present actionable solutions to improve quality outcomes and member experience
- Present quality, clinical, operational, or regulatory findings to leadership, providers, committees, and cross-functional stakeholders
Requirements
What you’ll need- Registered Nurse (RN) with unrestricted license in state of operations
- 5 years combined knowledge of healthcare processes
- Knowledge of managed care processes
- Organizational skills and ability to meet deadlines and manage multiple priorities
- Verbal and written communication skills
- PC experience including Microsoft Word, Access, and Excel
- Strong knowledge of common patient disease processes and usual methods of treating them
- Thorough knowledge of medical terminology and commonly used equipment
- Ability to evaluate medical records for appropriateness of care
- Ability to assess and judge the clinical performance of physicians and other health professionals
- Strong analytical, assessment, and problem-solving skills
- Effective oral and written communication skills, including explaining complex information and documenting according to standards
- Intermediate skills in Word, PowerPoint, Excel, and Outlook; basic ability to enter data into and navigate through a database
- Ability to maintain confidentiality of sensitive information
- Self-directed and able to work independently
- Strong attention to detail and work accuracy
- Preferred: presentation and facilitation skills
- Preferred: experience conducting clinical reviews, quality of care investigations, root cause analysis, and issue resolution
- Preferred: experience developing and delivering training or presentations
- Preferred: experience interpreting and communicating complex clinical information and findings
- Preferred: experience with Quality of Care, Quality Management, Quality Improvement, Patient Safety, Risk Management, Appeals, Grievances, or related programs
- Preferred: knowledge of CMS, NCQA, Medicare, Medicaid, and related regulatory requirements
- Sponsorship is not available
Benefits
Comp & perks- Curated development plans and professional development
- Health and wellness benefits
- 401(k) savings plan
- Pension plan
- Paid time off
- Paid parental leave
- Disability insurance
- Supplemental life insurance
- Employee assistance program
- Paid holidays
- Tuition reimbursement
- Annual incentive bonus plan
- Other incentives
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Quality ManagementMedical Record EvaluationPatient Disease Process KnowledgeRoot Cause AnalysisData Analysis
Soft Skills
Organizational SkillsVerbal Communication SkillsWritten Communication SkillsAttention to DetailSelf-Directed Work
Tools & Technologies
Microsoft WordMicrosoft ExcelMicrosoft AccessMicrosoft PowerPointDatabase Navigation
Certifications & Qualifications
Registered Nurse (RN) License
Industry Keywords
Quality of CareManaged Care ProcessesCMSNCQAMedicareMedicaidPatient SafetyRisk Management