Clinical - Quality Improvement Auditor (Clinical) - 210664

Location : 100% Remote. Candidate(s) can be sourced nationwide.

SHIFT : Must be able to work 08 : 00am / 5 : 00pm AZ time, with 1 hour lunch, Mon Fri. There may be instances of required OT when approved by management.

Duration : Temp staff for HEDIS season abstraction / overreading, roughly around 4 Months

Job Description : Job Profile Summary

• 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.

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.

Responsibilities

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.

Must haves : HEDIS Experience, Knowledge of HEDIS Hybrid Measures Preferred

Nice to haves : Previous Quality Experience, Previous Auditing Experience

Licenses / Certifications : Current state s clinical license (LPN, RN, etc.).

Candidate Requirements Required : Bachelor s degree in nursing, related field or equivalent experience and requires an clinical license Preferred : Required : RN, LVN, LPN License Preferred :