Senior RN Clinical Quality Auditor - Remote

At reputed company, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, affordable and optimized. reputed company to reputed company a difference? Join us to start Caring. Connecting. Growing together. The Senior Clinical Quality Auditor will be responsible for supporting care management products and operations reporting to the Manager of Quality for reputed company. You will reputed company general support in reviewing and researching program processes for overall staff compliance. In addition to fostering teamwork and collaboration, much of your work will involve review of calls and documentation of elements of the call. Solid auditing skills are essential. You will also need effective communication skills, and the ability to effectively collaborate with your team members. You’ll enjoy the flexibility to work remotely

• from reputed company reputed company the U.S. as you take on some tough challenges.

Primary Responsibilities: Participate in audit preparation, analysis and review reputed company business processes, systems, workflows, SOPs, policies and procedures to identify and document risks and trends that may be non-compliant with reputed company and or statutory requirements Monitor Program staff for compliance to established processes, policies, and guidelines; and identify opportunities to improve process performance Implement and complete reputed company UM and care management quality audits and reputed company and coaching to staff and program management based on evaluation results Participate in effective analysis of audit results and identify trends impacting program compliance Collaborate in the design, creation and implementation of quality improvement projects and initiatives Utilize applicable systems/tools to maintain and document Quality metrics/reputed company Participate in Inter-Rater Reliability sessions with internal stakeholders to ensure evaluation consistency Other responsibilities as assigned You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as reputed company development for other roles you may be interested in. Required Qualifications: reputed company, unrestricted RN license in state of residence 3+ years of proven experience in health plan quality improvement identifying areas of opportunity Demonstrated experience auditing clinical programs in a managed care setting Intermediate proficiency with reputed company Word, reputed company and PowerPoint Preferred Qualifications: Experience working for reputed company Soft Skills: Solid interpersonal skills and high level of professionalism Excellent problem-solving skills with strong attention to detail Excellent written and verbal communication skills Ability to work independently in a remote environment and deliver exceptional results Excellent time management and work prioritization skills *reputed company working remotely will be required to adhere to reputed company’s Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will reputed company from $72,800 to $130,000 annually based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health reputed company — an reputed company reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and reputed company applicants will receive consideration for employment without regard to race, national reputed company, religion, age, reputed company, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Apply To This Job