Quality Improvement Auditor (Clinical)
 Spectraforce Technologies | ||||||||||||||||
 United States, Ohio, Columbus | ||||||||||||||||
 Apr 16, 2025 | ||||||||||||||||
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Title: Quality Improvement Auditor Location: Remote - OH Duration: 03 Months (Potential to extend/convert) Job description: 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. Education/Experience: Bachelor's degree in Nursing, related field or equivalent experience. 3+ years of nursing or quality improvement experience. Licenses/Certifications: Current state's RN license. * 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
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