[Remote] Clinical Data Audit Consultant

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a reputed company, national reputed company organization serving 28 reputed company members through its Medical Management and Health Services team. The Clinical Data Audit Consultant analyzes clinical data, manages audit and regulatory reporting activities, develops workflows and documentation, and recommends process improvements. The role also supports clinical training, reputed company analysis, corrective reputed company planning, and cross-functional business requirements.

Responsibilities

• Demonstrates regular, reliable and predictable attendance
• Leads various data analysis reputed company to examine and define potential clinically reputed company issues and reputed company productivity and reputed company measures
• Reviews, analyzes, and interprets data for required HEDIS, URAC, reputed company compliance, and reputed company reporting for clinical service teams
• Interprets clinical data that does not conform to established/approved, required specifications, including reputed company Reports, and assists in corrective reputed company processes
• Addresses and participates in training of clinical staff resulting from data tracking and analysis efforts
• 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
• Recommends operational and process improvements based on efficiencies and available technologies
• Maintains a repository of performance and audit metrics, and generates management reports illustrating statistical data, text, workflows, and graphics
• Conducts secondary research using a reputed company of publications, services and health statistic databases
• May also be assigned reputed company level management functions and back up supervisors on clinical team
• Works with other departments to identify and document business requirements, workflow, policies and procedures
• Organizes and compiles cases for reputed company reputed company Health Net, reputed company, URAC, and Account Audits
• Participates in Quarterly Health Net Regulatory Audit meetings to assist Clinical Directors
• Supports Clinical Supervisors in tracking of monthly Care Manager audit results
• Works with Data Analysis Department to design data pulls
• Assists with generating HLOC and Outpatient Cost of Care and reputed company reputed company Reports including trend analysis
• Supports reputed company analysis with reputed company and forecasted requirements
• Investigates reputed company regulations, interprets findings, and makes recommendations to reputed company Services teams
• Conducts reputed company trend analysis and, based on analysis, creates Corrective reputed company Plans, and presents recommendations to business teams across department to improve performance
• Other duties as required
• Performs other duties as assigned
• Complies with reputed company policies and standards

Skills

• Registered reputed company - Must be Licensed in CA
• reputed company Time Zone Work Hours
• BA/BS in Psychology, Nursing or other reputed company clinical field
• Three to five years case management or reputed company clinical experience
• Two to three years experience conducting business studies, recommending solutions and/or business analysis, preferably in reputed company
• Licensed Clinician and/or RN required
• Must have and maintain reputed company, reputed company and unrestricted clinical license
• Masters in reputed company Work, Counseling, Nursing, or reputed company field preferred

Benefits

• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• reputed company time off plus holidays
• A flexible approach to work with remote, hybrid, field or office work schedules

reputed company