Quality Improvement Auditor (Clinical) [Immediate Start] Position Available In New York, New York

Job Description:

You could be the one who changes everything for our 28 millionmembers. Centene is transforming the health of our communities, oneperson at a time. As a diversified, national organization, you’llhave access to competitive benefits including a fresh perspectiveon workplace flexibility. Travel is required within the Albany,Syracuse, Booklyn, the Bronx, Long Island, New York City, Queens,or surrounding areas in the state of New York. HEDIS experiencehighly preferred.

Position Purpose:

Lead medical record audits,monitor and analyze clinical documentation, and modify businessprocesses to measure member outcomes. Assess provider performanceand quality of care through clinical case reviews.

• Lead clinicalaudits for provider medical records both remotely via electronicmedical records and on site to assess performance, determine trendsand compile written reports summarizing findings, includingclinical recommendations to assure the delivery of quality services
• Lead case reviews to assess the clinical performance provided inthe provider network, including written clinical summaries andrecommendations
• Perform ongoing quantitative and statisticalanalysis of the business unit’s performance data to include variouscontracted performance measures, service utilization andmember/provider complaint and quality of care trends
• Coordinatewith internal teams to assure audit requests are fully understood,accurately compiled and delivered timely
• Perform otherperformance and process improvement activities
• Performs otherduties as assigned
• Complies with all policies and standards

Education/Experience:

Bachelor’s degree in nursing, related fieldor equivalent experience and requires an clinical license. 3 yearsof nursing or quality improvement experience.

Licenses/Certifications:

Current state’s clinical license (LPN, RN,etc.).

Pay Range:

$55,100.00

• $99,000.

00 per year Centene offers acomprehensive benefits package including: competitive pay, healthinsurance, 401K and stock purchase plans, tuition reimbursement,paid time off plus holidays, and a flexible approach to work withremote, hybrid, field or office work schedules. Actual pay will beadjusted based on an individual’s skills, experience, education,and other job-related factors permitted by law. Total compensationmay also include additional forms of incentives. Centene is anequal opportunity employer that is committed to diversity, andvalues the ways in which we are different. All qualified applicantswill receive consideration for employment without regard to race,color, religion, sex, sexual orientation, gender identity, nationalorigin, disability, veteran status, or other characteristicprotected by applicable law. Qualified applicants with arrest orconviction records will be considered in accordance with the LACounty Ordinance and the California Fair Chance Act