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Quality Improvement Auditor (Clinical) Job in Grove City, Ohio US

Quality Improvement Auditor (Clinical)

Spectraforce Technologies Inc - Grove City, OH

Posted: 4/16/2025 - Expires: 7/15/2025

Job ID: 288053090

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Job Description

Title: Quality Improvement Auditor

Location: Remote - OH

Duration: 03 Months (Potential to extend/convert)

Job description:

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

Education/Certification

Required: Bachelor's degree in nursing, or equivalent exp.

Preferred:

Licensure

Required: Ohio RN license

Preferred:

Years of experience required

Must haves: 3+ years of nursing and/or quality improvement experience. 2+ years of working with the HEDIS technical specifications and/or medical record abstraction. Comfortability making outbound phone calls to health systems and/or provider groups.

Nice to haves: Experience with Transitions of Care (TRC) HEDIS Measure. Proficiency with Microsoft Excel. Experience communicating with stakeholders.

Top 3 must-have hard skills

1

Medical Record Abstraction (2 years+)

2

Microsoft Excel (Basic to Intermediate skill level)

3

Outbound fax

SPECTRAFORCE is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, age, sexual orientation, gender identity, genetic information, disability or veteran status, or any other category protected by applicable federal, state, or local laws. Please contact Human Resources at nahr@spectraforce.com if you require reasonable accommodation.

Job Summary

Employment Type:
Full Time Employee
Job type:
Federal Contractor
Skill Based Partner:
No
Education Level:
Bachelor's degree
Work Days:
Mon, Tue, Wed, Thu, Fri
Job Reference Code
83341627
Salary
N/A
Licenses / Certifications:
N/A
Display Recommended WorkKeys®Recommended WorkKeys®:
Applied Math: 4
Graphic Literacy: 4

Workplace Documentation: 4