The Clinical Data and Audit Consultant-CA Only is responsible for the clinical content component of all data collection, account implementations, and audit activities for Clinical Operations to ensure high-quality tracking and performance of the service teams. The Consultant gathers and analyzes data, creates workflows, coordinates internal and external audits, and analyzes and documents business processes to meet all clinical, procedural, account, and regulatory requirements. Demonstrates regul... more details
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
Must reside in California!
Centene is hiring a remote Clinical Data Audit Consultant in California to audit and complete trend analysis. The ideal candidate will have managed care experience.
Position Purpose: The Clinical Data and Audit Consultant-CA Only is responsible for the clinical content component of all data collection, account implementations, and audit activities for Clinical Operations to ensure high-quality tracking and performance of the service teams.
The Consultant gathers and analyzes data, creates workflows, coordinates internal and external audits, and analyzes and documents business processes to meet all clinical, procedural, account, and regulatory requirements.
Reviews, analyzes, and interprets data for required HEDIS, URAC, NCQA compliance, and related reporting for clinical service teams.
Interprets clinical data that does not conform to established/approved, required specifications, including Unity Reports, and assists in corrective action processes.
Identifies, evaluates, recommends and documents clinical business needs and objectives, operational processes and procedures, problems and requirements.
Produces documentation, including project plans, analytical reports, decision backup, information research reports, training plans, business justifications, graphics, workflow and business process models.
Maintains a repository of performance and audit metrics, and generates management reports illustrating statistical data, text, workflows, and graphics.
Conducts complex trend analysis and, based on analysis, creates Corrective Action Plans, and presents recommendations to business teams across department to improve performance.
Education/Experience:
BA/BS in Psychology, Nursing or other related clinical field; Masters in Social Work, Counseling, Nursing, or related field preferred
Three to five years case management or related clinical experience
Two to three years experience conducting business studies, recommending solutions and/or business analysis, preferably in Healthcare
License/Certification: Licensed Clinician and/or RN required. Must have and maintain current, valid and unrestricted clinical license.
Pay Range: $32.41 - $58.31 per hour
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.