Quality Nurse Navigator (RN or LPN)

Summary BlueCross BlueShield of South Carolina is hiring a Quality Nurse Navigator to monitor and implement quality improvement activities, conduct medical reviews, analyze findings, recommend corrective actions, and manage HEDIS data collection. Location & Work Hours Full-time, 40 hrs/week, Monday‑Friday 8:00‑5:00 EST. Hybrid in Columbia, SC or fully remote in South Carolina. Occasional on‑site reporting for trainings or meetings. Responsibilities Perform quality improvement activities to ensure compliance with applicable standards and regulations. Analyze, document, and present findings of quality improvement activities. Recommend corrective actions and improvements when necessary. Conduct quality medical record reviews to monitor quality of care and services provided. Track, trend, and investigate quality concerns and complaints. Coordinate HEDIS data collection. Requirements Required Education: Associate’s degree in a related field. Required Experience: 4 years clinical or behavioral health experience, including 2 years in quality management. Required Licensure: Active, unrestricted licensure in Behavioral Health or a registered nurse (RN), RN compact, registered health information administrator (RHIA), or unrestricted LPN in the state of hire. Proficiency with Microsoft Office. Strong verbal and written communication, customer service, organizational, presentation, problem‑solving, and analytical or critical‑thinking skills. Proficient spelling, grammar, punctuation, and basic business math. Ability to handle confidential or sensitive information with discretion. Demonstrated ability to identify needs and implement corrective actions. Strong understanding of managed care. Preferred Qualifications Ability to persuade, negotiate, or influence others. Knowledge of mathematical or statistical concepts. Willingness to travel to provider assignments and/or health events. Benefits Subsidized health, dental, and vision coverage. 401(k) retirement savings plan with company match. Life insurance. Paid time off (PTO). On‑site cafeterias and fitness centers at major locations. Education assistance. Service recognition program. National discounts to movies, theaters, zoos, theme parks, and more. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and its subsidiaries maintain a continuing policy of nondiscrimination in employment to promote opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, or genetic information. As a federal contractor, the company upholds affirmative action programs to promote opportunities for individuals with disabilities and protected veterans. We are committed to providing equal opportunities in all phases of the employment process and to complying with applicable federal, state, and local laws and regulations. We provide reasonable accommodations for individuals with disabilities, pregnant individuals, and those with sincerely held religious beliefs, as long as accommodations do not impose undue hardship on the company. #J-18808-Ljbffr