Clinical Data Audit Consultant

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Centene Corporation

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Contracting • Network Development • Managed Care

10,000+

Description

• Responsible for the clinical content component of all data collection, account implementations, and audit activities for Clinical Operations to ensure high-quality tracking and performance of the service teams • Gathers and analyzes data, creates workflows, coordinates internal and external audits, and analyzes and documents business processes to meet all clinical, procedural, account, and regulatory requirements • Leads various data analysis projects to examine and define potential clinically related issues and track productivity and quality measures • Reviews, analyzes, and interprets data for required HEDIS, URAC, NCQA compliance, and related reporting for clinical service teams • Addresses and participates in training of clinical staff resulting from data tracking and analysis efforts • Produces documentation, including project plans, analytical reports, decision backup, information research reports, training plans, business justifications, graphics, workflow and business process models • Maintains a repository of performance and audit metrics, and generates management reports illustrating statistical data, text, workflows, and graphics • Conducts complex trend analysis and, based on analysis, creates Corrective Action Plans, and presents recommendations to business teams across department to improve performance • Complies with all policies and standards

Requirements

• BA/BS in Psychology, Nursing or other 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 • Licensed Clinician and/or RN required. Must have and maintain current, valid and unrestricted clinical license.

Benefits

• competitive pay • health insurance • 401K and stock purchase plans • tuition reimbursement • paid time off plus holidays • flexible approach to work with remote, hybrid, field or office work schedules