обновлено 2 дня назад
RN Clinical Quality Assurance Auditor (Nashville)
Вакансия из Hirify Global, списка международных tech-компанийДля мэтча и отклика нужен Plus
Мэтч & Сопровод
Для мэтча с этой вакансией нужен Plus
Описание вакансии
Текст:
TL;DR
RN Clinical Quality Assurance Auditor (HEDIS/STARS): Conducting clinical quality, compliance, and inter-reviewer audits, reviewing medical records, and analyzing healthcare data to improve Star measure outcomes and member care with an accent on regulatory compliance, audit accuracy, and provider education. Focus on presenting audit results, identifying quality risks, coordinating HEDIS/STARS record retrieval, and developing process improvements.
Location: Nashville, TN, United States; preference for candidates living in Nashville to support occasional onsite visits to provider offices
Company
is a health insurance organization focused on quality, compliance, and member care outcomes.
What you will do
- Perform quality, compliance, inter-reviewer, facility, practitioner site, and medical record audits.
- Review and abstract medical records and analyze clinical data for HEDIS and STARS data collection and quality-of-care reviews.
- Present audit results and provide education, feedback, and consulting support to providers and internal stakeholders.
- Identify compliance risks, liabilities, and improvement opportunities, and recommend process enhancements.
- Coordinate HEDIS and STARS record retrieval and provide oversight for regional contract staff.
- Support procedures, standards, and documentation for quality and regulatory audits.
Requirements
- Active Registered Nurse license in Tennessee or an active license from the state of residence under the Nurse Licensure Compact.
- At least 4 years of healthcare experience and 1 year of managed care or quality medical record review experience.
- Experience with HEDIS and/or STARS data collection.
- Bachelor's degree in a healthcare-related field or equivalent work experience.
- Strong analytical, presentation, facilitation, communication, planning, organizational, and research skills.
- Proficiency in Microsoft Office, including Outlook, Word, Excel, and PowerPoint; advanced Excel skills with pivot tables are preferred.
Culture & Benefits
- Employee position with support for innovation, creativity, growth, and continuous learning.
- Flexibility may be required to support provider or leadership needs outside standard business hours, including after 5:00 p.m.
- Immunizations and/or related medical tests may be required.
- Routine business driving may require participation in the company Driver Safety Program, a valid driver's license, compliant auto insurance, and an acceptable motor vehicle record.
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