Clinical Data Audit Consultant (Healthcare)

Location: Remote in California, United States; Pacific Time Zone work hours required

Salary: $33.71–$60.67 per hour

Company

hirify.global provides healthcare services and connects people with the care they need.

What you will do

• Analyze clinical data, productivity measures, quality metrics, and performance trends for clinical service teams.
• Review and interpret data for HEDIS, URAC, NCQA, Health Net, and account audit requirements.
• Coordinate internal and external audits, compile audit cases, and maintain performance and audit metric repositories.
• Develop workflows, business process documentation, project plans, analytical reports, training plans, and corrective action plans.
• Investigate regulations, identify clinical and operational issues, and recommend process improvements.
• Collaborate with data analysis, clinical leadership, supervisors, and other departments on data pulls, staffing analysis, reporting, and business requirements.

Requirements

• BA/BS in Psychology, Nursing, or a related clinical field.
• Licensed clinician and/or registered nurse with a current, valid, unrestricted California clinical license.
• Three to five years of case management or related clinical experience.
• Two to three years of experience conducting business studies, recommending solutions, or performing business analysis, preferably in healthcare.
• Ability to work reliably during Pacific Time Zone hours.

Nice to have

• Master’s degree in Social Work, Counseling, Nursing, or a related field.
• Experience with HEDIS, URAC, NCQA, Health Net, or healthcare regulatory audits.

Culture & Benefits

• Health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off, and holidays.
• Flexible work approaches, including remote, hybrid, field, and office schedules.
• Equal opportunity workplace committed to diversity and inclusion.
• Pay and total compensation may vary based on skills, experience, education, job-related factors, and employment status.