Business Process Auditor Associate providing assurance and advisory services within a health plan environment. Gaining experience in evaluating governance, risks, and controls across health plan operations.
About the role
- Quality Auditor/Reviewer Clinician conducting reviews of clinical records for compliance and quality. Collaborating with staff for ongoing education and quality improvement initiatives.
Responsibilities
- Conducts routine reviews of clinical records for quality, medical necessity and compliance
- Interacts with staff and managers to provide consultation, feedback, and ongoing education
- Provides quality improvement consultation related to quality of care and utilization review
- Reviews data and trends to identify and coordinate improvement activities
- Develops and maintain updates of training for staff to implement process changes and improve performance
Requirements
- Master's degree in social services field
- Independent licensure in area of specialization
- Three plus years of experience including some experience in quality program review
- Demonstrated competencies in clinical administration and delivery
- Good planning, interpersonal and communication skills
Benefits
- Health insurance
- Professional development
- Competitive salaries and benefits
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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