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Req. No


Job Title

Clinical Quality Auditor


CHRISTUS System Office


Quality and Risk Management


Minimum Overnight Travel Up To 10 Percent


CHRISTUS Corp Health Plan 919 and 909 Buildings


919 Hidden Ridge
Irving, TX  75038
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Clinical Quality Auditor Job in Irving

Job Description


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.

  • 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 documentations and authorization to ensure compliance with regulation, policy and procedures for multiple lines of business
  • This includes collecting, aggregating, sorting and communicating 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


  • Associate degree in Nursing

Work Type: 

Full Time

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Clinical Quality Auditor