Hybrid Clinical Quality Auditor Lead

Posted 3 weeks ago

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About the role

  • 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

Benefits

  • merit increases
  • paid holidays
  • Paid Time Off
  • incentive bonus programs
  • medical benefits
  • dental benefits
  • vision benefits
  • short and long term disability benefits
  • 401(k) +match
  • stock purchase plan
  • life insurance
  • wellness programs
  • financial education resources

Job title

Clinical Quality Auditor Lead

Job type

Experience level

Senior

Salary

Not specified

Degree requirement

Bachelor's Degree

Location requirements

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