Clinical Quality Auditor Lead performing audits and ensuring compliance with quality standards at Elevance Health. Mentoring staff and preparing for oversight audits across various locations in the U.S.
Responsibilities
Prepares team for oversight audits
Prepares corrective action plans in response to oversight body's request
Conducts audits of Quality Management (QM) processes and files
Writes policies and procedures and assists with development of provider manuals, audit tools, and guidelines
Responsible for specific QM processes/functions (i.e. compliance, grievances/appeals or HEDIS/quality improvement projects)
Assists manager with day-to-day monitoring and prioritizing of workflows and activities
Develops and improves departmental processes and operations
Monitors goals, performance and processes
Assists with issues of non-compliance
Mentors and coaches staff
Trains new associates and re-trains current associates
Monitors and prioritizes workflows
Serves as a resource and a subject matter expert
Requirements
Requires BS in nursing, health sciences, health management or a related clinical field
Minimum of 5 years of experience in utilization management, quality assurance and/or regulatory/accreditation standards/audits
Minimum of 3 years of quality management experience
Current active unrestricted license such as an RN, LCSW, LMSW, LMHC, LPC, LBA
Strong oral, written and interpersonal communication skills
Problem-solving skills
Facilitation skills
Analytical skills
For associates working within Puerto Rico: current PR health certificate and current PR Law 300 certificate are required
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