Clinical Data Audit Consultant

Centene Corporation; Deutschland; Hybrid; EUR 40.000 - 72.000; Vollzeit

Benefits dieser Stelle

Health insurance

401K

Tuition reimbursement

Paid time off

Flexible work schedules

Zusammenfassung

Centene Corporation is seeking a Registered Nurse licensed in CA to join the Medical Management/Health Services team in a clinical data and audit role. Pacific Time Zone work hours with flexible remote/hybrid options, focusing on data analysis, audits, and regulatory compliance for health plan operations.

The position emphasizes data-driven decision making, cross-team collaboration, and improving performance metrics across external audits and internal processes.

Qualifikationen

• BA/BS in Psychology, Nursing or other related clinical field; Masters in Social Work, Counseling, Nursing, or related field preferred
• Three to five years case management or related clinical experience
• Two to three years experience conducting business studies, recommending solutions and/or business analysis, preferably in Healthcare

Aufgaben

• The Clinical Data and Audit Consultant is responsible for the clinical content component of all data collection, account implementations, and audit activities for Clinical Operations to ensure high-quality tracking and performance of the service teams.
• Gathers and analyzes data, creates workflows, coordinates internal and external audits, and analyzes and documents business processes to meet all clinical, procedural, account, and regulatory requirements
• Produces documentation, including project plans, analytical reports, decision backup, information research reports, training plans, business justifications, graphics, workflow and business process models
• Maintains a repository of performance and audit metrics, and generates management reports illustrating statistical data, text, workflows, and graphics

Kenntnisse

Data analysis

Audit coordination

Regulatory compliance

Clinical data

Project coordination

Ausbildung

Bachelor's degree in psychology, nursing or related clinical field

Master's degree in social work, counseling, nursing or related field

Tools

Unity Reports

Jobbeschreibung

Aug 14, 2026

$33 - $60/hour

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Registered Nurse - Must be Licensed in CA

Pacific Time Zone Work Hours

Position Purpose: The Clinical Data and Audit Consultant is responsible for the clinical content component of all data collection, account implementations, and audit activities for Clinical Operations to ensure high-quality tracking and performance of the service teams.

The Consultant gathers and analyzes data, creates workflows, coordinates internal and external audits, and analyzes and documents business processes to meet all clinical, procedural, account, and regulatory requirements.

Demonstrates regular, reliable and predictable attendance.

Leads various data analysis projects to examine and define potential clinically related issues and track productivity and quality measures

Reviews, analyzes, and interprets data for required HEDIS, URAC, NCQA compliance, and related reporting for clinical service teams

Interprets clinical data that does not conform to established/approved, required specifications, including Unity Reports, and assists in corrective action processes

Addresses and participates in training of clinical staff resulting from data tracking and analysis efforts

Identifies, evaluates, recommends and documents clinical business needs and objectives, operational processes and procedures, problems and requirements

Produces documentation, including project plans, analytical reports, decision backup, information research reports, training plans, business justifications, graphics, workflow and business process models

Recommends operational and process improvements based on efficiencies and available technologies

Maintains a repository of performance and audit metrics, and generates management reports illustrating statistical data, text, workflows, and graphics

Conducts secondary research using a variety of publications, services and health statistic databases

May also be assigned lower level management functions and back up supervisors on clinical team

Works with other departments to identify and document business requirements, workflow, policies and procedures

Organizes and compiles cases for all External Health Net, NCQA, URAC, and Account Audits

Participates in Quarterly Health Net Regulatory Audit meetings to assist Clinical Directors

Supports Clinical Supervisors in tracking of monthly Care Manager audit results

Works with Data Analysis Department to design data pulls

Assists with generating HLOC and Outpatient Cost of Care and Target Outlier Reports including trend analysis

Supports staffing analysis with current and forecasted requirements

Investigates current regulations, interprets findings, and makes recommendations to Healthcare Services teams

Conducts complex trend analysis and, based on analysis, creates Corrective Action Plans, and presents recommendations to business teams across department to improve performance

Other duties as required

Performs other duties as assigned

Complies with all policies and standards

Education/Experience:

• BA/BS in Psychology, Nursing or other related clinical field; Masters in Social Work, Counseling, Nursing, or related field preferred
• Three to five years case management or related clinical experience
• Two to three years experience conducting business studies, recommending solutions and/or business analysis, preferably in Healthcare

License/Certification: Licensed Clinician and/or RN required. Must have and maintain current, valid and unrestricted clinical license.

Pay Range: $33.71 - $60.67 per hour

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Transforming the health of the communities we serve, one person at a time.

Centene Corporation is a leading healthcare enterprise providing affordable, high-quality services to underserved populations through local health plans and government-sponsored programs.