Quality Improvement Auditor (Clinical) jobs in United States
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Peach State Health Plan · 1 day ago

Quality Improvement Auditor (Clinical)

positionUnited States
timeFull-time
remoteRemote
seniorityMid Level
money$56K/yr - $101K/yr
date3+ years exp

Peach State Health Plan is part of Centene, a diversified national organization focused on transforming the health of communities. The Quality Improvement Auditor will lead medical record audits and clinical case reviews to assess provider performance and quality of care, while analyzing clinical documentation and business processes.

Health Care

Responsibilities

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

Qualification

Clinical auditingClinical documentation analysisStatistical analysisNursing licenseQuality improvement experienceTeam coordinationCommunication skills

Required

Bachelor's degree in nursing, related field or equivalent experience
Requires a clinical license
3+ years of nursing or quality improvement experience
Current state's clinical license (LPN, RN, etc.)

Preferred

Candidates who currently reside in Georgia are strongly preferred

Benefits

Health insurance
401K
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays

Company

Peach State Health Plan

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Peach State Health Plan is a Care Management Organization that provides health care services through its provider network. It is a sub-organization of Centene.
dateFounded in 2006
location
Atlanta, Georgia, USA
people-size201-500 employees
web-link
http://www.pshpgeorgia.com/

Funding

Current Stage
Growth Stage

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