Clinical Quality Assurance Auditor

Modivcare

3d

About The Position

Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you! This position is responsible for proactive Clinical Quality Auditor to support the ongoing monitoring and evaluation of call quality, ensuring compliance with industry regulations, and enhancing the overall customer experience. In addition to auditing calls and processes, this role will also be responsible for processing clinical escalations and assisting with resolving any related issues. This role… Audit Strategy & Implementation: Implements audit strategies to assess the quality of calls, compliance with healthcare regulations, and overall adherence to quality standards. Conduct audits on calls, clinical charts, processes, procedures, and systems to ensure adherence to industry standards. Escalations: Process and respond to unresolved escalations (issues that arise in calls that are unable to be resolved in the moment), working closely with relevant teams to address issues and provide timely resolutions. Clinical Escalations: Complete reviews of clinical escalations resulting from outlier biometrics for process and quality recommendations. Audit Reporting & Communication: Communicates audit findings, analysis, and recommendations to senior management and key stakeholders. Highlight trends, actionable insights, and areas requiring improvement. Corrective Action Planning: Collaborates with internal teams to identify action plans and implement corrective actions based on audit findings. Tracks and monitors the progress of these action plans. Team Development & Coaching: Provides coaching and development to team members on job skills, delivery skills, and quality improvement. Offers targeted support for individuals needing additional coaching on soft skills or specific job tasks to enhance team performance. Compliance Monitoring: Ensures ongoing compliance with quality standards, industry regulations, and internal policies by extracting and evaluating calls. Monitors and assists in meeting compliance and productivity goals. Trend Analysis & Reporting: Analyze call data to identify trends, gaps, and areas for improvement. Prepare reports to share with senior management for decision-making purposes. Communication with Stakeholders: Build and maintain strong relationships with internal and external stakeholders, including healthcare providers, patients, and regulatory agencies. Ensure clear communication of audit results and next steps to involved parties. Handles routine inquiries and relay information between departments and stakeholders. Maintains security and access to sensitive materials. Assists with maintaining productivity and quality goals. Monitors and assists with QA chat channels to provide real-time support. Performs other duties as assigned by management.

Requirements

• Bachelor's Degree in health related field required.
• Five (5) plus years of clinical experience.
• Current and unobstructed RN licensure (Preferred) Or equivalent combination of education and/or experience.
• Strong attention to detail and organizational skills.
• Collaborative and team-oriented approach.
• Ability to handle sensitive and confidential information.
• Problem-solving mindset and proactive in addressing challenges.
• Adaptable and flexible in responding to changing business needs.
• Strong knowledge of industry regulations, compliance standards, and audit processes.
• Excellent analytical skills with the ability to identify trends and provide actionable insights.
• Strong communication skills, both written and verbal, with the ability to report findings and collaborate with various departments.
• Experience in coaching and training team members to improve performance and achieve quality goals.
• Ability to work independently, prioritize tasks, and manage multiple projects simultaneously.
• Familiarity with clinical processes and the handling of clinical escalations is a plus.
• Proficiency in quality assurance software, data analysis tools, and Microsoft Office Suite (Excel, Word, PowerPoint).

Responsibilities

• Implements audit strategies to assess the quality of calls, compliance with healthcare regulations, and overall adherence to quality standards.
• Conduct audits on calls, clinical charts, processes, procedures, and systems to ensure adherence to industry standards.
• Process and respond to unresolved escalations (issues that arise in calls that are unable to be resolved in the moment), working closely with relevant teams to address issues and provide timely resolutions.
• Complete reviews of clinical escalations resulting from outlier biometrics for process and quality recommendations.
• Communicates audit findings, analysis, and recommendations to senior management and key stakeholders.
• Highlight trends, actionable insights, and areas requiring improvement.
• Collaborates with internal teams to identify action plans and implement corrective actions based on audit findings.
• Tracks and monitors the progress of these action plans.
• Provides coaching and development to team members on job skills, delivery skills, and quality improvement.
• Offers targeted support for individuals needing additional coaching on soft skills or specific job tasks to enhance team performance.
• Ensures ongoing compliance with quality standards, industry regulations, and internal policies by extracting and evaluating calls.
• Monitors and assists in meeting compliance and productivity goals.
• Analyze call data to identify trends, gaps, and areas for improvement.
• Prepare reports to share with senior management for decision-making purposes.
• Build and maintain strong relationships with internal and external stakeholders, including healthcare providers, patients, and regulatory agencies.
• Ensure clear communication of audit results and next steps to involved parties.
• Handles routine inquiries and relay information between departments and stakeholders.
• Maintains security and access to sensitive materials.
• Assists with maintaining productivity and quality goals.
• Monitors and assists with QA chat channels to provide real-time support.
• Performs other duties as assigned by management.

Benefits

• Medical, Dental, and Vision insurance
• Employer Paid Basic Life Insurance and AD&D
• Voluntary Life Insurance (Employee/Spouse/Child)
• Health Care and Dependent Care Flexible Spending Accounts
• Pre-Tax and Post --Tax Commuter and Parking Benefits
• 401(k) Retirement Savings Plan with Company Match
• Paid Time Off
• Paid Parental Leave
• Short-Term and Long-Term Disability
• Tuition Reimbursement
• Employee Discounts (retail, hotel, food, restaurants, car rental and much more!)

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level