Healthcare Quality Management Auditor (Field-Based - Maricopa County, Arizona)

CVS Health • Chandler, AZ

71d • Onsite

About The Position

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position SummaryThe Healthcare Quality Management Auditor participates in the development and ongoing implementation of QM (quality management) Work Plan activities. This person will improve quality products and services by using measurement and analysis to process, evaluate, and make recommendations to meet QM objectives.

Requirements

• Active RN (Registered Nurse) or LPN (Licensed Practical Nurse) license, valid in the state of Arizona.
• 1+ year of experience in behavioral health and/or long-term care.
• Must reside in Arizona.
• Ability to travel in Arizona up to 80% of the time.
• Demonstrated proficiency in Microsoft Office Suite, primarily Excel.

Nice To Haves

• Previous experience working in a provider setting.
• Previous experience with medical record QM auditing and/or case management.
• Strong attention to detail.
• Ability to learn quickly and remain adaptable amidst an evolving environment.
• Strong relationship building skills.
• Previous experience in an outpatient behavioral health environment.
• Previous experience working with medical records and/or Electronic Health Records (EHR).

Responsibilities

• Completes a variety of onsite medical and clinical audits for all lines of business, including AHCCCS (Arizona Health Care Cost Containment System), DES (Department of Economic Security) and DCS-CHP (Department of Child Safety - Comprehensive Health Plan).
• Conducts exit interviews with clinical and leadership staff to review audit results.
• Assists with developing corrective action plans.
• Develops audit tools for all populations.
• Tracks completion of corrective action plans.
• Completes data entry on all audit tools.
• Participates in completing inter rater reliability and scoring guidelines.
• Participates in QM meetings.

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Ambulatory Health Care Services
• Number of Employees: 5,001-10,000 employees