Quality Improvement Auditor - Clinical

4 days ago

🗽 New York – Remote

Although this job is listed in New York, this company may be open to hiring remote in other states.

💵 $55.1k - $99k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

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Centene Corporation

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Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

Contracting • Network Development • Managed Care

10,000+ employees

Founded 1984

⚕️ Healthcare Insurance

🤝 Non-profit

🌍 Social Impact

📋 Description

• 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

🎯 Requirements

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

🏖️ 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