Quality Improvement Auditor (Clinical)

Position Title: Quality Improvement Auditor (Clinical)

Work Location: Remote

Assignment Duration: 04 months

Work Arrangement: 08:00am/5:00pm AZ time, with 1 hour lunch, Mon - Fri. (There may be instances of required OT when approved by management)

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.

Key Responsibilities:

• RN or LPN/LVN will review medical records to determine if they meet predetermined requirements/standards for HEDIS measures and collect associated data. Previous HEDIS experience preferred.
• Individuals will review between 50-100 records per 8-hour day (based on HEDIS measures reviewed) with 95% or better accuracy.
• 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