Clinical - Quality Improvement Auditor (Clinical) - 210664 Job at Pacer Group, Rhode Island

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  • Pacer Group
  • Rhode Island

Job Description

Position Title: Quality Improvement Auditor
Location: Remote (Nationwide)
Duration: 4 Months
Schedule: Monday Friday, 8:00 AM 5:00 PM AZ Time (1-hour lunch). Occasional OT with manager approval.


Responsibilities:

  • Lead medical record audits remotely through EMRs.
  • Review provider documentation to assess performance and identify trends.
  • Compile written reports summarizing findings and clinical recommendations.
  • Conduct clinical case reviews and prepare written summaries.
  • Perform ongoing quantitative/statistical analysis of performance data, including HEDIS measures, utilization, complaints, and quality-of-care trends.
  • Coordinate with internal teams to ensure audit requests are understood and delivered accurately and on time.
  • Review 50 100 medical records per day (measure-dependent) with 95%+ accuracy.
  • Support performance and process improvement activities.
  • Comply with all policies and standards and perform additional duties as assigned.

Requirements:

Education & Licensure (Required):

  • Bachelor's degree in Nursing or related field, or equivalent experience.
  • Active clinical license (RN, LPN, LVN).

Experience (Required):

  • 3+ years of nursing or quality improvement experience.

Must-Have Skills:

  • Knowledge of HEDIS Hybrid Measures.
  • Proficiency with TEAMS, Excel, EMRs, QMRM.
  • Strong organization and ability to meet deadlines.

Preferred:

  • Previous HEDIS experience.
  • Experience in quality improvement or clinical auditing.

Job Tags

Monday to Friday,

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