Quality Nurse Navigator (RN or LPN)

We are currently hiring for a Quality Nurse Navigator at BlueCross BlueShield of South Carolina. In this role you will monitor and implement quality improvement activities, conduct medical reviews, analyze findings, recommend corrective actions, and prepare formal documentation for compliance. You will also coordinate HEDIS data collection and participate in NCQA accreditation activities. Location and Schedule Full‑time (40hrs/week), Monday‑Friday 8:00am–5:00pm EST. Hybrid in Columbia, SC or fully remote in South Carolina with occasional on‑site attendance. Responsibilities Perform quality improvement activities to maintain compliance with standards and regulations. Analyze, document, and present findings from quality improvement activities. Recommend corrective actions and drive process improvement. Conduct quality medical record reviews to monitor care quality. Track, trend, and investigate quality concerns and complaints. Coordinate HEDIS data collection. Required Qualifications Associate’s degree in a relevant field. At least 4years of clinical or behavioral health experience, including 2years in quality management. Strong verbal and written communication, customer service, organizational, presentation, problem‑solving, and analytical skills. Proficient spelling, grammar, punctuation, and basic business math. Ability to handle confidential information with discretion. Demonstrated ability to identify and implement corrective actions. Strong understanding of managed care. Proficient with MicrosoftOffice. Active, unrestricted licensure in Behavioral Health (or RN, LPN, RHIA as listed) in the state of hire. Preferred Qualifications Persuasive, negotiation, or influence skills. Knowledge of mathematical or statistical concepts. Willingness to travel to provider assignments 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 (where available). Education assistance. Service recognition. National discounts to movies, theaters, zoos, and theme parks. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina is an equal‑opportunity employer. We comply with all applicable federal, state, and local laws and provide reasonable accommodations for qualified individuals with disabilities, pregnancy, or sincerely held religious beliefs. #J-18808-Ljbffr