Clinical Data & Audit Consultant - Remote/Hybrid

Health Net; Texas; Hybrid; USD 46.000 - 84.000; Vollzeit

Zusammenfassung

Centene is seeking a Clinical Data and Audit Consultant responsible for the clinical content component of data collection, audits, and implementations to ensure high-quality tracking and performance for Clinical Operations. The role requires an active RN license and experience in data analysis, reporting, and compliance with HEDIS/URAC/NCQA standards.

The position supports clinical teams through data interpretation, action planning, and training, with opportunities to contribute to process

Qualifikationen

• BA/BS in Psychology, Nursing or 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

• 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 and assists in corrective action processes
• Addresses and participates in training of clinical staff resulting from data tracking and analysis efforts
• Produces documentation including project plans, analytical reports and training plans
• Maintains a repository of performance and audit metrics and generates management reports
• Organizes and compiles cases for External Health Net, NCQA, URAC audits
• Supports Clinical Supervisors in tracking of monthly Care Manager audit results
• Works with Data Analysis Department to design data pulls
• Assists with generating reports including trend analysis and cost of care

Ausbildung

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

Masters in Social Work, Counseling, Nursing, or related field preferred

Jobbeschreibung

Centene is seeking a Clinical Data and Audit Consultant responsible for the clinical content component of data collection, audits, and implementations to ensure high-quality tracking and performance for Clinical Operations. The role requires an active RN license and experience in data analysis, reporting, and compliance with HEDIS/URAC/NCQA standards.

The position supports clinical teams through data interpretation, action planning, and training, with opportunities to contribute to process