Clinical Data Audit Consultant

Centene
California, Idaho, New Mexico, Arizona, Utah, Washington, Colorado, Oregon, Texas, Nevada
Workplace: RemoteFull timeUSD 33.71 - 60.67 hourlyFunction: Quality & Regulatory (Non-Software)Education: bachelorsSkills: ["Data analysis","Documentation","Process improvement","Training","Cross-functional collaboration"]

Serve as a clinical data and audit consultant for Clinical Operations, owning the clinical content component of data collection, account implementations, and audit activities. Gather and analyze clinical and operational data, build workflows, and coordinate internal/external audits to meet HEDIS, URAC, NCQA, and related reporting requirements. Interpret nonconforming clinical data (including Unity Reports), lead corrective action efforts, and produce compliance documentation, metrics, and management reporting.

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FursaFursa
Centene
Centene
4 days ago

Clinical Data Audit Consultant

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Last checked: 3 hours agoStatus: Live

Job Summary

Serve as a clinical data and audit consultant for Clinical Operations, owning the clinical content component of data collection, account implementations, and audit activities. Gather and analyze clinical and operational data, build workflows, and coordinate internal/external audits to meet HEDIS, URAC, NCQA, and related reporting requirements. Interpret nonconforming clinical data (including Unity Reports), lead corrective action efforts, and produce compliance documentation, metrics, and management reporting.
Location: California, Idaho, New Mexico, Arizona, Utah, Washington, Colorado, Oregon, Texas, Nevada
Workplace: Remote
Employment Type: Full time
Job Function: Quality & Regulatory (Non-Software)
Seniority: Mid level

Key Responsibilities

  • •Own the clinical content component of data collection, account implementations, and audit activities for Clinical Operations.
  • •Gather, analyze, and document clinical business processes and data to meet clinical, procedural, account, and regulatory requirements.
  • •Review and interpret data for required HEDIS, URAC, and NCQA compliance reporting for clinical service teams.
  • •Coordinate and support internal and external audits, including organizing cases for External Health Net, NCQA, URAC, and Account Audits.
  • •Conduct complex trend analysis and develop corrective action plans; generate management reports and support training resulting from data tracking and analysis.

Pay and Benefits

Salary: USD 33.71 - 60.67 hourly
Perks:Health Insurance401kEquityPaid Leave

Key Requirements

  • •BA/BS in Psychology, Nursing or other related clinical field; Masters in Social Work, Counseling, Nursing, or related field preferred.
  • •Three to five years of case management or related clinical experience.
  • •Two to three years experience conducting business studies, recommending solutions and/or business analysis, preferably in Healthcare.
  • •Licensed Clinician and/or RN required; must have and maintain current, valid and unrestricted clinical license.
  • •Must be licensed in CA and work Pacific Time Zone hours.
Experience:HealthcareClinical operations
Education:Bachelor's in Psychology, Nursing
Skills:Data analysisDocumentationProcess improvementTrainingCross-functional collaboration
Licenses:RNClinical license
Tech Stack:Unity ReportsHEDISURACNCQAHealth NetExternal Health Net

Company Brief

Centene
Centene Corporation is a diversified, multinational healthcare enterprise that provides government-sponsored and commercial healthcare programs and services, specializing in Medicaid, Medicare, and specialty benefits management across the United States.
Industry: Health Insurance (Payers)
Company Size: Enterprise (1,001+ employees)
Revenue: USD 1B+
Growth: Public Company
Valuation: Public Company (Market Cap in USD)
Funding: IPO / Publicly Listed
Headquarters: St. Louis, United States
Founded: 1984
WebsiteLinkedIn