Clinical Data Audit Consultant

Centene; California; À distance; USD 47 000 - 84 000; Plein temps

Avantages offerts par ce poste

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules

Résumé du poste

Centene is seeking a Clinical Data Audit Consultant to oversee the clinical content component of data collection, audits, and account implementations for Clinical Operations. This role suits candidates with strong analytical skills and clinical data management experience, including supporting HEDIS, URAC, and NCQA compliance.

The position offers a remote CA location, full-time day shift, and competitive benefits such as health insurance and 401K.

Qualifications

• BA/BS in Psychology, Nursing, or related clinical field; Masters preferred.
• 3-5 years case management or related clinical experience.
• 2-3 years experience in business studies or analysis, preferably in Healthcare.
• Licensed Clinician and/or RN required; current license required.

Responsabilités

• Gather and analyze data for clinical operations.
• Create workflows and coordinate internal and external audits.
• Review, analyze, and interpret data for HEDIS, URAC, NCQA compliance.
• Address and participate in training of clinical staff based on data analysis.
• Identify, evaluate, and document clinical business needs and objectives.
• Produce documentation including project plans and analytical reports.
• Recommend operational and process improvements.
• Maintain a repository of performance and audit metrics.
• Conduct secondary research using health statistic databases.
• Organize and compile cases for external audits.

Connaissances

Data analysis

Audit coordination

Clinical data management

Healthcare analytics

Formation

BA/BS in Psychology, Nursing, or related clinical field

Masters preferred

Description du poste

About This Role

The Clinical Data Audit Consultant is responsible for the clinical content component of data collection, account implementations, and audit activities for Clinical Operations. This role is ideal for individuals with strong analytical skills and experience in clinical data management.

Highlights

• Pay: $33.71 - $60.67 per hour
• Location: Remote, CA
• Schedule: Full Time, Day shift

What You'll Do

• Gather and analyze data for clinical operations.
• Create workflows and coordinate internal and external audits.
• Review, analyze, and interpret data for HEDIS, URAC, NCQA compliance.
• Address and participate in training of clinical staff based on data analysis.
• Identify, evaluate, recommend, and document clinical business needs and objectives.
• Produce documentation including project plans and analytical reports.
• Recommend operational and process improvements.
• Maintain a repository of performance and audit metrics.
• Conduct secondary research using various health statistic databases.
• Organize and compile cases for external audits.

Requirements

Education

• BA/BS in Psychology, Nursing, or related clinical field; Masters preferred

Experience

• 3-5 years case management or related clinical experience
• 2-3 years experience in business studies or analysis, preferably in Healthcare

Licenses & Certifications

• Licensed Clinician and/or RN required
• Must maintain a current, valid, and unrestricted clinical license

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible work schedules

About Centene

Centene is a diversified, national organization committed to delivering exceptional healthcare services. They offer competitive benefits and a fresh perspective on workplace flexibility, ensuring a supportive environment for their employees.