Quality Improvement Auditor (Clinical) at Fidelis Care summary: The Quality Improvement Auditor (Clinical) leads medical record audits and clinical case reviews to assess provider performance and quality of care. They analyze clinical documentation and business processes to measure member outcomes and identify trends. The role involves coordinating audit activities, compiling reports with clinical recommendations, and supporting continuous performance improvement.

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Travel is required within the Albany, Syracuse, Booklyn, the Bronx, Long Island, New York City, Queens, or surrounding areas in the state of New York. HEDIS experience highly preferred. 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. 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

Performs other duties as assigned

Complies with all policies and standards

Education/Experience: Bachelor’s degree in nursing, related field or equivalent experience and requires an clinical license. 3+ years of nursing or quality improvement experience.

Licenses/Certifications: Current state’s clinical license (LPN, RN, etc.).Pay Range: $55,100.00 - $99,000.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Keywords: quality improvement, clinical audit, medical record review, HEDIS, performance measurement, clinical documentation, healthcare compliance, data analysis, provider performance, care quality