Quality Improvement Auditor (clinical)

Oklahoma Complete Health; New York (NY); Remote; USD 55,000 - 99,000; Full time

Job summary

A leading healthcare organization is seeking a Quality Improvement Auditor to lead clinical audits, analyze documentation, and improve business processes. The role offers flexibility with remote work options and a comprehensive benefits package. Candidates should have a nursing degree and relevant experience.

Benefits

Health Insurance

401K

Stock Purchase Plans

Tuition Reimbursement

Paid Time Off

Flexible Work Schedules

Qualifications

• 3+ years of nursing or quality improvement experience.

Responsibilities

• Lead medical record audits and analyze clinical documentation.
• Assess provider performance and quality of care through reviews.
• Perform ongoing quantitative and statistical analysis.

Skills

Quality Improvement

Clinical Auditing

Data Analysis

Education

Bachelor’s degree in nursing

Clinical license

Job description

Quality Improvement Auditor (clinical) page is loaded

Quality Improvement Auditor (clinical)

Apply locations Rego Park - New York City Regional Office-95-25 Queens Blvd(10815) Remote-NY time type Full time posted on Posted 3 Days Ago job requisition id 1561124

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

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.

• Lead clinical audits for provider medical records both remotely via electronic medical records and on site to assess performance, determine trends and compile written reports summarizing findings, including clinical recommendations to assure the delivery of quality services
• Lead case reviews to assess the clinical performance provided in the provider network, including written clinical summaries and recommendations
• Perform ongoing quantitative and statistical analysis of the business unit’s performance data to include various contracted performance measures, service utilization and member/provider complaint and quality of care trends
• Coordinate with internal teams to assure audit requests are fully understood, accurately compiled and delivered timely
• Perform other performance and process improvement activities
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience: Bachelor’s degree in nursing, related field or equivalent experience and requires an clinical license. 3+ years of nursing or quality improvement experience.

Licenses/Certifications: Current state’s clinical license (LPN, RN, etc.).Pay Range: $55,100.00 - $99,000.00 per year

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. Total compensation may also include additional forms of incentives.

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

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