Quality Audit Professional - Remote

Overview

The Quality Audit Professional 2 analyzes and investigates quality issues, supporting the Healthcare Quality Management Team in administering the Clinical Quality Management Program to ensure quality healthcare for beneficiaries.

In Short

• Analyze and investigate quality issues.
• Support the Clinical Quality Management Program.
• Review medical records and summarize issues.
• Work with Medical Directors on corrective actions.
• Participate in departmental projects.
• Ensure compliance with established guidelines.
• Make independent decisions regarding work methods.
• Monitor case entries for accuracy and timeliness.
• Present cases to the Patient Safety Peer Review Committee.
• Maintain data in Provider Trending Database.

Requirements

• U.S. citizenship required.
• Active RN license in state of employment.
• 3 years clinical RN experience.
• 2 years of UR, CM, or QM experience.
• Strong analytical skills.
• Ability to work 7 - 4 p.m. or 8 - 5 p.m. E.T.
• Experience with accreditation (URAC, NCQA, JCAHO) preferred.
• Ability to work from home with appropriate internet connection.
• Occasional travel may be required.

Benefits

• Competitive medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off and holidays.
• Short-term and long-term disability.
• Life insurance and other opportunities.