Quality Improvement Auditor

Position Title : Quality Improvement Auditor

Work Location : Remote - GA (Must be EST timezone)

Assignment Duration : 12 months Remote - GA

Position Summary :

The associate will conduct medical record audits for clinical practice guidelines and perform potential quality of care investigations. This role requires provider outreach via phone, fax and US Mail to providers to obtain medical records for review.

CPGs- review and score the record using an approved tool.

Potential Quality of Care concerns - require immediate request of medical records and every seven day follow up via phone / email / fax and documentation. An investigation takes place once the record is received (review the chart to determine if the allegations are substantiated). A Medical Director (MD) reviews specific cases.

The candidate will be required to write of reports and analyze simple data, review and update policies / procedure, collaborate with other departments as applicable.

This is not a HEDIS record review position. Although HEDIS medical records may provide experience with revieing records and some auditing, this role is not a record auditor only.

Background & Context :

Key Responsibilities :

Qualification & Experience :

Education / Certification Required : Bachelor's degree in nursing, related field or equivalent experience and requires an clinical license. 3+ years of nursing or quality improvement experience. Preferred :

Licensure Required : RN, LPN in GA and / or compact Preferred :

Years of experience required : 3 years experience in position same or similar to Quality Improvement Auditor, Audit experience -writing, reporting experience

Disqualifiers : Most previous position must be related field, misspelling, job hopping (please state if contract),

Additional qualities to look for : preferably PQOC / QOC, administrative audits or CPG, Clear and concise

• Top 3 must-have hard skills stack-ranked by importance 1 Audit experience, compliance, investigation experience, reporting

2 Preferred - Knowledge of PQOC / QOC investigation process

3 Clear and concise writing

Candidate Requirements

Education / Certification

Required : Bachelor's degree in nursing, related field or equivalent experience and requires an clinical license. 3+ years of nursing or quality improvement experience.

Preferred : Licensure

Required : RN, LPN in GA and / or compact

Preferred : Licensure

Disqualifiers : Most previous position must be related field, misspelling, job hopping (please state if contract),

Additional qualities to look for : preferably PQOC / QOC, administrative audits or CPG, Clear and concise

Audit experience, compliance, investigation experience, reporting

Preferred - Knowledge of PQOC / QOC investigation process

Clear and concise writing