Clinical Data & Audit Lead (Remote/Hybrid)

Centene Corporation; United States; Remote; USD 47,000 - 83,000; Full time

Benefits offered by this job

Health insurance

401K plans

Stock purchase plans

Tuition reimbursement

Paid time off

Flexible schedules

Job summary

Centene Corporation is seeking a Clinical Data and Audit Consultant to oversee the clinical content component of data collection, audits, and related workflows. The role focuses on high-quality tracking and performance of service teams within Clinical Operations.

The position requires an RN license in CA with Pacific Time Zone work hours, and emphasizes data analysis, regulatory reporting, and collaboration with cross-functional teams to improve care outcomes.

Qualifications

• BA/BS in Psychology, Nursing or related clinical field.
• Three to five years case management or related clinical experience.
• Two to three years experience conducting business studies or analysis in Healthcare.

Responsibilities

• 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 HEDIS, URAC, NCQA compliance and related reporting.
• Interprets clinical data and assists in corrective action processes.
• Addresses and participates in training of clinical staff from data tracking and analysis.
• Produces documentation including project plans, analytical reports, and training plans.
• Recommends operational improvements based on efficiencies and available technologies.
• Maintains a repository of performance and audit metrics with management reports.
• Organizes cases for External Health Net, NCQA, URAC audits.

Skills

Data analysis

Audit coordination

HEDIS compliance

URAC compliance

NCQA compliance

Clinical data

Workflow design

Training staff

Regulatory knowledge

Education

BA/BS in Psychology, Nursing or related clinical field

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

Job description

Centene Corporation is seeking a Clinical Data and Audit Consultant to oversee the clinical content component of data collection, audits, and related workflows. The role focuses on high-quality tracking and performance of service teams within Clinical Operations.

The position requires an RN license in CA with Pacific Time Zone work hours, and emphasizes data analysis, regulatory reporting, and collaboration with cross-functional teams to improve care outcomes.