Remote RN: Clinical Data & Audit Consultant

Health Net; Arizona; Hybride; USD 46 000 - 84 000; Plein temps

Résumé du poste

Centene is seeking a Clinical Data and Audit Consultant to manage clinical data content for data collection, audits, and compliance programs. The role focuses on supporting Clinical Operations with high-quality tracking, reporting, and performance improvement.

The successful candidate will have clinical licensure and experience in HEDIS/URAC/NCQA reporting, data interpretation, and cross-functional collaboration to drive process enhancements.

Qualifications

• 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.

Responsabilités

• Leads various data analysis projects to examine clinically related issues and track productivity and quality measures.
• Reviews, analyzes, and interprets data for required HEDIS, URAC, NCQA compliance, and related reporting.
• 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 business justifications.
• Maintains a repository of performance and audit metrics and generates management reports.

Connaissances

Data analysis

Healthcare analytics

Regulatory compliance

Auditing

Reporting

Formation

BA/BS in Psychology or Nursing

Masters in Social Work, Counseling, Nursing or related field

Outils

Unity Reports

Description du poste

Centene is seeking a Clinical Data and Audit Consultant to manage clinical data content for data collection, audits, and compliance programs. The role focuses on supporting Clinical Operations with high-quality tracking, reporting, and performance improvement.

The successful candidate will have clinical licensure and experience in HEDIS/URAC/NCQA reporting, data interpretation, and cross-functional collaboration to drive process enhancements.