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.

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