Quality Improvement Auditor (Clinical)

Centene; United States; Remote; USD 55,000 - 99,000; Full time

Job summary

A leading healthcare organization is seeking a qualified professional to lead medical record audits and improve clinical documentation. This role involves assessing provider performance and ensuring quality care through comprehensive analysis. The ideal candidate will have a nursing background and experience in quality improvement. Competitive benefits and flexible work arrangements are offered.

Benefits

Health Insurance

401K

Stock Purchase Plans

Tuition Reimbursement

Paid Time Off

Flexible Work Arrangements

Qualifications

• Minimum of 3 years of nursing or quality improvement experience.

Responsibilities

• Lead clinical audits for provider medical records both remotely and on-site.
• Perform ongoing quantitative and statistical analysis of performance data.
• Coordinate with internal teams to ensure audit requests are understood.

Skills

Quality Improvement

Clinical Documentation

Statistical Analysis

Education

Bachelor’s degree in nursing

Job description

Job Opportunity at Centene

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.

Travel is required within the Albany, Syracuse, Brooklyn, the Bronx, Long Island, New York City, Queens, or surrounding areas in the state of New York.

HEDIS experience highly preferred.

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.

1. 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 with clinical recommendations to ensure the delivery of quality services.
2. Lead case reviews to assess clinical performance within the provider network, including written clinical summaries and recommendations.
3. Perform ongoing quantitative and statistical analysis of the business unit’s performance data, including contracted performance measures, service utilization, and member/provider complaint and quality of care trends.
4. Coordinate with internal teams to ensure audit requests are fully understood, accurately compiled, and delivered in a timely manner.
5. Participate in other performance and process improvement activities.
6. Perform other duties as assigned.
7. Comply with all policies and standards.

Education/Experience:

Bachelor’s degree in nursing or a related field, or equivalent experience, with a clinical license. Minimum of 3 years of nursing or quality improvement experience.

Licenses/Certifications:

Current clinical license (LPN, RN, etc.) valid in the state. 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 flexible work arrangements (remote, hybrid, field, or office schedules). Actual compensation will be adjusted based on skills, experience, education, and other factors permitted by law. Total compensation may include additional incentives.

Centene is an equal opportunity employer committed to diversity. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.