Remote Quality Improvement Auditor (clinical) – LTC


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Business Area: Quality
Job Type: Full time
Date Posted: Jun 06 2024
Job Number: 1502256


You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Candidate must reside in the state of Arizona

Position Purpose:

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

  • Lead clinical audits for provider medical records both remotely via electronic medical records and on site to assess performance, determine trends and compile written reports summarizing findings, including clinical recommendations to assure the delivery of quality services
  • Lead case reviews to assess the clinical performance provided in the provider network, including written clinical summaries and recommendations
  • Perform ongoing quantitative and statistical analysis of the business unit’s performance data to include various contracted performance measures, service utilization and member/provider complaint and quality of care trends
  • Coordinate with internal teams to assure audit requests are fully understood, accurately compiled and delivered timely.
  • Perform other performance and process improvement activities
  • Limited in state travel.

Education/Experience: Master’s degree in Healthcare Management, Business Management, Social Work, or related field. 3+years of performance and statistical analysis or quality improvement experience. Proficient in Microsoft Office applications. Previous experience in public sector managed care or managed behavioral health care preferred. Experience with standard statistics software preferred.

License/Certification: LCSW, LMFT, LPC, LISAC, or RN licensed in Arizona. AZ Independent Behavioral Health License and valid driver’s license. Certified Professional in Healthcare Quality (CPHQ) preferred.Pay Range: $54,000.00 – $97,100.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual’s skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.