What are the responsibilities and job description for the Clinical - Quality Improvement Auditor (Clinical) position at Axelon Services Corporation?
Location : Remote. Candidate(s) can be sourced nationwide.
SHIFT : 08 : 00am / 5 : 00pm AZ time, with 1 hour lunch, Mon Fri. There may be instances of required OT when approved by management
Duration :
3 FEB 2025 2 May 2025, No potential to Extend
Reason for opening : Temp assistance with overreading for HEDIS season.
Job Description :
- RN or LPN / LVN will review medical records to determine if they meet predetermined requirements / standards for HEDIS measures and collect associated data. Previous HEDIS experience preferred.
Describe the performance expectations / metrics for this individual and their team :
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.
Education / Experience : Bachelor s degree in Nursing, related field or equivalent experience. 3 years of nursing or quality improvement experience.
Licenses / Certifications : Current state s RN license.
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
Required Skills / Experience :
Clinical Experience Required
Preferred Skills / Experience :
HEDIS Experience Preferred
RN, LVN, LPN License
Provider Office Experience (Pediatric, Family / Internal Medicine, etc.)
Microsoft Office Proficiency
Previous Quality Experience
Medical Terminology / Specialty Competency
Previous Auditing Experience
Education Requirement :
Nursing Degree
Education Preferred :
Software Skills Required :
Microsoft Office, Electronic Health Records
Required Certifications :
Required Testing :
Must pass HEDIS measure testing prior to week 3
