Clinical - Quality Improvement Auditor (Clinical) - 210664

Below mentioned is the job description for your reference:

Position Title: Quality Improvement Auditor

Location: Remote

Duration: 4 Months (Contract)

Schedule: Monday Friday, 8:00 AM 5:00 PM (Arizona Time)

Job Summary:

The Quality Improvement Auditor will be responsible for conducting comprehensive medical record reviews to assess provider performance, ensure compliance with HEDIS and quality measures, and support process improvement initiatives. This role involves leading clinical audits, reviewing provider documentation, and compiling data-driven reports to enhance care quality and member outcomes. The position is remote and can be sourced nationally.

Key Responsibilities:

• Conduct clinical audits of provider medical records (remote and/or onsite) to assess care quality and compliance with performance measures.
• Review and analyze HEDIS hybrid measures and collect associated data with at least 95% accuracy.
• Lead case reviews to evaluate provider clinical performance and prepare written summaries and recommendations.
• Perform quantitative and statistical analysis of business unit performance data, service utilization, and quality-of-care trends.
• Collaborate with internal teams to ensure audit requests are accurately compiled and delivered on time.
• Participate in performance and process improvement activities as needed.

Education & Experience Requirements:

• Required: Bachelor's degree in Nursing or a related field (or equivalent experience).
• Licensure: Active RN, LPN, or LVN license in good standing (any state).
• Experience: Minimum of 3 years in nursing or quality improvement.
• Preferred: Prior HEDIS, medical record review, or clinical auditing experience.

Skills & Competencies:

• Strong understanding of HEDIS hybrid measures and quality reporting standards.
• Proficient in Excel, Microsoft Teams, EMRs, and QMRM tools.
• Excellent organizational skills with the ability to manage high-volume record reviews (50 100 records/day).
• Strong analytical, written, and verbal communication skills.
• Ability to work independently in a remote environment with strict accuracy and productivity standards.

Work Details:

• Location: Remote (Nationwide)
• Schedule: Monday Friday, 8:00 AM 5:00 PM (Arizona Time)
• Duration: Approx. 4 months (Temporary for HEDIS season abstraction/overreading)