Quality Improvement Auditor (Clinical)

Centene Corporation•Indianapolis, IN

4d•Remote

About The Position

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. POSITION IS REMOTE BUT CANDIDATE MUST RESIDE IN THE STATE OF INDIANA AND HOLD RN LICENSURE 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 Performs other duties as assigned Complies with all policies and standards

Requirements

Bachelor’s degree in nursing, related field or equivalent experience and requires an clinical license.
3+ years of nursing or quality improvement experience.
Current state’s clinical license (LPN, RN, etc.).
MUST RESIDE IN THE STATE OF INDIANA AND HOLD RN LICENSURE

Responsibilities

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