Clinical Data Audit Consultant

Job not on LinkedIn

🕒 August 14

🌵 Arizona, California, +8 more states – Remote

🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🥔 Idaho – Remote 🎰 Nevada – Remote 🌶️ New Mexico – Remote 🌲 Oregon – Remote 🤠 Texas – Remote ⛷️ Utah – Remote ☕ Washington – Remote

💵 $33 - $60 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Responsible for the clinical content component of data collection, account implementations, and audit activities for Clinical Operations • Gather and analyze data, create workflows, coordinate internal and external audits, and analyze and document business processes • Lead data analysis projects examining clinically related issues and tracking productivity and quality measures • Review and interpret data for HEDIS, URAC, NCQA compliance and related reporting • Interpret nonconforming clinical data and assist in corrective action processes • Participate in training clinical staff based on data tracking and analysis • Identify, evaluate, recommend and document clinical business needs, objectives, processes, procedures, problems and requirements • Produce project plans, analytical reports, research reports, training plans, business justifications, graphics, workflows and process models • Recommend operational and process improvements • Maintain performance and audit metrics repositories and generate management reports • Conduct secondary research using publications, services and health statistic databases • Back up supervisors and perform lower-level management functions as assigned • Collaborate with departments to document business requirements, workflows, policies and procedures • Organize and compile cases for External Health Net, NCQA, URAC and Account Audits • Participate in Quarterly Health Net Regulatory Audit meetings • Support Clinical Supervisors in tracking monthly Care Manager audit results • Work with Data Analysis Department to design data pulls • Generate HLOC and Outpatient Cost of Care and Target Outlier Reports, including trend analysis • Support staffing analysis using current and forecasted requirements • Investigate regulations, interpret findings and recommend actions to Healthcare Services teams • Conduct complex trend analysis, create Corrective Action Plans and present recommendations to business teams • Perform other duties as assigned and comply with policies and standards

🎯 Requirements

• BA/BS in Psychology, Nursing or another related clinical field required • Licensed Clinician and/or RN required • Must have and maintain a current, valid and unrestricted clinical license • Three to five years of case management or related clinical experience • Two to three years of experience conducting business studies, recommending solutions and/or business analysis, preferably in Healthcare • Must be currently licensed in California • Pacific Time Zone work hours • Regular, reliable and predictable attendance

🏖️ Benefits

• Health insurance • 401K plan • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation • Equal opportunity employer committed to diversity