Quality Improvement Auditor – Clinical

Job Description: • Lead medical record audits, monitor and analyze clinical documentation, and modify business processes to measure member outcomes • Assess provider performance and quality of care through clinical case reviews • Lead clinical audits for provider medical records both remotely via electronic medical records and on site to assess performance, determine trends and compile written reports summarizing findings, including clinical recommendations to assure the delivery of quality services • Lead case reviews to assess the clinical performance provided in the provider network, including written clinical summaries and recommendations • Perform ongoing quantitative and statistical analysis of the business unit’s performance data to include various contracted performance measures, service utilization and member/provider complaint and quality of care trends • Coordinate with internal teams to assure audit requests are fully understood, accurately compiled and delivered timely • Perform other performance and process improvement activities • Performs other duties as assigned • Complies with all policies and standards Requirements: • Bachelor’s degree in nursing, related field or equivalent experience and requires an clinical license • 3+ years of nursing or quality improvement experience • Current state’s clinical license (LPN, RN, etc.) Benefits: • competitive pay • health insurance • 401K and stock purchase plans • tuition reimbursement • paid time off plus holidays • flexible approach to work with remote, hybrid, field or office work schedules Apply tot his job Apply To this Job