Job Description
Position Title: Quality Improvement Auditor
Location: Remote (Nationwide)
Duration: 4 Months
Schedule: Monday Friday, 8:00 AM 5:00 PM AZ Time (1-hour lunch). Occasional OT with manager approval.
Responsibilities:
- Lead medical record audits remotely through EMRs.
- Review provider documentation to assess performance and identify trends.
- Compile written reports summarizing findings and clinical recommendations.
- Conduct clinical case reviews and prepare written summaries.
- Perform ongoing quantitative/statistical analysis of performance data, including HEDIS measures, utilization, complaints, and quality-of-care trends.
- Coordinate with internal teams to ensure audit requests are understood and delivered accurately and on time.
- Review 50 100 medical records per day (measure-dependent) with 95%+ accuracy.
- Support performance and process improvement activities.
- Comply with all policies and standards and perform additional duties as assigned.
Requirements:
Education & Licensure (Required):
- Bachelor s degree in Nursing or related field, or equivalent experience.
- Active clinical license (RN, LPN, LVN).
Experience (Required):
- 3+ years of nursing or quality improvement experience.
Must-Have Skills:
- Knowledge of HEDIS Hybrid Measures.
- Proficiency with TEAMS, Excel, EMRs, QMRM.
- Strong organization and ability to meet deadlines.
Preferred:
- Previous HEDIS experience.
- Experience in quality improvement or clinical auditing.
Job Tags
Remote work, Monday to Friday,