Quality Improvement Auditor (Clinical and BH) -- Remote Available
Quality Improvement Auditor (Clinical and BH) -- Remote AvailablePeach State Health Plan
Atlanta, GA 30339
You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose: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
Our Comprehensive Benefits Package:
- Flexible work solutions including remote options, hybrid work schedules and dress flexibility
- Competitive pay
- Paid Time Off including paid holidays
- Health insurance coverage for you and dependents
- 401(k) and stock purchase plans
- Tuition reimbursement and best-in-class training and development
Education/Experience:Bachelor’s degree in Nursing, related field or equivalent experience. 3+ years of nursing or quality improvement experience.
Licenses/Certifications: Current state’s RN license.
Office based position with some travel
Ideal candidate will have a background in clinical and behavioral health
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.