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Work Schedule/Shift

8AM-5PM

Job ID

5000491182706

Req. No

70038954

Job Title

Clinical Quality Auditor

Region

CHRISTUS System Office

Category

Healthcare

Division

Not Defined

Company

CHRISTUS Health

Travel

None

Facility

Corp USFHP-55100

Address

919 Hidden Ridge
Irving, TX  75038
US

Type

Full Time

Apply Now Clinical Quality Auditor Job in Irving

This position performs audit functions for the Quality Management team and delegated vendors and partners to determine operational efficiency, adherence to regulatory requirements and achievement of quality standards.

Duties and Responsibilities:

  • The Quality Clinical Auditor will conduct, review, analyze and summarize findings of audit plans for internal business units and delegated partners and entities on a monthly, quarterly and/or annual basis. Focuses specifically on HEDIS audits and initiatives, supporting documentation and authorization to ensure compliance with regulation, policy, and procedures for multiple lines of business. This includes collecting, aggregating, sorting and communicating a summary of data collected and utilizing excel pivot tables, charts and graphs to share findings and prepare materials for reporting purposes.
  • Assist with evaluating and analyzing ad hoc quality performance data to develop strategies for implementing Performance Improvement initiatives. This includes identifying opportunities for improvement, problem prioritization and creating performance improvement plans for non-compliant audits and/or reports.
  • Contribute creative solutions and ownership of daily assignments for seamless communication and systematic completion of routine and special projects.
  • Working under the direction of the Quality Director maneuvers multiple tasks independently with a fast-paced proactive vs. reactive approach to changing priorities.
  • Maintain tracking tools that will log unacceptable areas in the workflow and staff documentation performance indicating improvement is needed for discussion with management and/or at departmental team meetings.
  • Assist departments with creating and revising audit tools, as necessary, to ensure audits and reports are value added to the business(s) owner.
  • Assists in assuring regulatory compliance requiring Clinical RN oversight and review.
  • Investigates all potential quality of care issues reported in coordination with the Medical Director and Peer Review Committee.
  • Responsible for maintaining timely reporting for all regulatory reporting, including medical record review and Quality Improvement Plans/Performance Improvement Plans.
  • Participates in maintaining compliance with URAC and NCQA accreditation standards.
  • Complete in-office provider audits and education as deemed appropriate pertaining to HEDIS and potential quality issues.
  • Registered Professional Nurse (RN) License.
  • Experience in medical records review claims processing or utilization/case management in clinical practice or managed care organization. This should include experience analyzing various types of data and processes with the ability to present findings and recommendations
  • Experience in Quality Management initiatives, reporting and HEDIS oversight
  • NCQA and URAC survey preparation
  • Experience in Medicare Advantage, Health Exchange and Medicaid lines of business
  • Availability to travel up to 20% for auditing purposes and member safety oversight
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