Clinical Quality Assurance Auditor (Healthcare)

TL;DR

Clinical Quality Assurance Auditor (Healthcare): Performing quality, compliance, and inter-reviewer audits to ensure consistency and regulatory adherence in medical record reviews with an accent on HEDIS and STARS data collection. Focus on analyzing clinical data, educating stakeholders, and driving clinical excellence to improve member outcomes.

Location: Must be based in the USA, with a preference for candidates living in Chattanooga or Nashville for occasional onsite provider visits.

Company

hirify.global is a health insurance provider dedicated to improving the quality of member care through innovation and clinical excellence.

What you will do

• Perform routine facility, practitioner site, and medical record reviews using established clinical audit tools.
• Analyze clinical data to identify trends, potential liabilities, and opportunities for process improvement.
• Communicate audit results to stakeholders and provide education to improve provider compliance.
• Coordinate efforts for HEDIS and STARS record retrieval and quality reviews.
• Participate in the development of procedures and standards to support quality of care goals.
• Consult on quality and compliance audits to ensure adherence to national accreditation standards.

Requirements

• Registered Nurse (RN) with an active Tennessee license or a license from a Nurse Licensure Compact state.
• 4 years of healthcare experience.
• 1 year of managed care experience or experience with Quality Medical Record Review.
• Experience with HEDIS and/or STARS data collection.
• Strong analytical, planning, and organizational skills.
• Proficiency in Microsoft Office, specifically Excel (pivot tables), Word, and PowerPoint.

Culture & Benefits

• Supportive environment that encourages innovation, creativity, and continuous learning.
• Access to tools and resources necessary for professional growth.
• Commitment to diversity and equal employment opportunity.
• Flexibility to adapt to changing business needs.