Quality Improvement Auditor

Position Title : Quality Improvement Auditor

Work Location : Remote (Nationwide)

Assignment Duration : Roughly 4 Months

Work Schedule : 08 : 00am-5 : 00pm AZ time, 1-hour lunch, Mon-Fri

Work Arrangement : Remote

Position Summary :

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.

Background & Context :

Temp staff supporting HEDIS season abstraction / over-reading. (All client names replaced with "our organization.")

Key Responsibilities :

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 / Certification

Required : Bachelor's degree in nursing, related field or equivalent experience and requires an clinical license

Preferred : Licensure

Required : RN, LVN, LPN License

Preferred : Licensure

• Disqualifiers
• Best vs. average
• Performance indicators

Must haves : HEDIS Experience Preferred

Nice to haves : Previous Quality Experience, Previous Auditing Experience

Disqualifiers :

Performance indicators :

Knowledge of HEDIS Hybrid Measures

Ability to utilize technology proficiently (TEAMS, Excel, EMR's, QMRM)

Ability to stay organized and meet deadlines