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Blue Cross Blue Shield of Arizona Logo Blue Cross Blue Shield of Arizona · Nursing

Quality Management Nurse

United States, Phoenix Employment contract · Job Posted May 05, 2026
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Job Description

This position is responsible for leading and coordinating the clinical quality review process of quality of care concerns. In addition, facilitates the ongoing activities of the Medicare & Medicaid Performance Department to fulfill regulatory requirements. The position also coordinates activities to meet contractual and reporting timeframes, and for anticipating needs as related to established policies and procedures, and the Medicare & Medicaid Performance Plan and assisting with revisions when needed.

Job Responsibility

  • Participate in development, implementation and evaluation of Quality Management programs
  • Investigate Quality of Care Concerns including tracking and root cause analysis
  • Ensure compliance with Corrective Action Plans and Performance Improvement Projects
  • Interface with regulatory agencies as necessary to ensure compliance with regulations
  • Monitor provider performance through administrative data and medical record review
  • Participate in Quality Management and Peer Review committees
  • Assist in the development of the Quality Management Program Description
  • Assist in the development of the Quality Management Work Plan and annual evaluation
  • Conduct audits of delegated entities as required by regulations
  • Act as Subject Matter Expert on Quality Management
  • Demonstrate and maintain current working knowledge of the required BCBSAZ systems, procedures, forms and manuals
  • Maintain all standards in consideration of State, Federal, BCBSAZ and other applicable regulatory/accrediting agency requirements as they apply to department functions
  • The position requires a full-time work schedule
  • Perform all other duties as assigned

Requirements

  • 3 years of experience in Managed Care
  • 3 years of Quality Management experience
  • Bachelor's degree in business, nursing, or related area
  • Active, current, and unrestricted license to practice in the State of Arizona as a Registered Nurse

Nice to have

  • 5 years of experience in Managed Care Quality Management
  • Master of Social Work
  • Certified Professional in Healthcare Quality
  • Knowledge of information systems including Microsoft office suite, plus public, and proprietary software applications
  • Project Management
  • Knowledge of a variety of software applications to manage HEDIS® project
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