Quality Improvement Auditor (Clinical)

Spectraforce Technologies; Maricopa (AZ); Remote; USD 70,000 - 85,000; Full time

Job summary

A leading healthcare provider is seeking a Quality Improvement Auditor to lead medical record audits and analyze clinical documentation. This remote role requires a Bachelor's in Nursing and 3+ years of relevant experience. The ideal candidate will have strong analytical skills and a current AZ RN license, with opportunities for extension and conversion to full-time employment.

Qualifications

• 3+ years of nursing or quality improvement experience.
• Current AZ License and Behavioral Health experience.

Responsibilities

• Lead clinical audits for provider medical records remotely.
• Conduct case reviews to evaluate clinical performance.
• Perform ongoing quantitative and statistical analysis of performance data.

Skills

Clinical Auditing

Quality Improvement

Data Analysis

Education

Bachelor's degree in Nursing

Master in Behavioral Health

Job description

Job Title: Quality Improvement Auditor (Clinical)

Job Location

Remote in AZ (Maricopa - Pima preferred; may require travel further, but the manager will try to keep it within their area). Approximately 10% of the job involves travel to provider locations on rotation with advanced notice.

Job Duration

3 Months (with the possibility to extend and convert to FTE).

Shift

8-hour days, Mon-Fri, 8 am-5 pm AZ time (some flexibility upon supervisor approval).

Position Purpose

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.

Education/Experience

Bachelor's degree in Nursing or related field, or equivalent experience. 3+ years of nursing or quality improvement experience.

Licenses/Certifications

Current state's RN license.

Responsibilities

1. Lead clinical audits for provider medical records remotely via electronic medical records and on-site to assess performance, identify trends, and compile reports with clinical recommendations to ensure quality services.
2. Conduct case reviews to evaluate clinical performance within the provider network, including written summaries and recommendations.
3. Perform ongoing quantitative and statistical analysis of performance data, including contracted performance measures, service utilization, and quality trends.
4. Coordinate with internal teams to ensure audit requests are understood, accurately compiled, and delivered timely.
5. Engage in other performance and process improvement activities.

Team Environment

• The QOC team is fairly autonomous, mainly comprising licensed nurses or social workers.
• Communication occurs via Teams and weekly structured meetings, along with regular team-building activities.
• The team reviews Incident, Accident, and Death (IAD) reports submitted in the Medicaid/AHCCCS portal.
• Investigate adverse outcomes indicated in IAD reports using all available resources, including medical records, policies, best practices, and AZ statutes.
• Manage assigned cases, tracking due dates of 30-60 days to ensure timely investigation and submission to AHCCCS.

Must Haves

Current AZ License and Behavioral Health experience.

Nice to Haves

Quality experience.

Candidate Requirements

1. 2+ years of clinical, quality management, or healthcare-related experience, including at least one year in a healthcare quality function.
2. Preferred: Master in Behavioral Health.
3. Licensure required: e.g., RN, BSN, LPN, etc.
4. Preferred: Licensure through AZ Board of Behavioral Health (Social Worker or Counselor).