On Site Quality Audit Specialist

BASIC FUNCTION:

This position is responsible for conducting provider/practitioner on-site office audits; reviewing and analyzing medical record keeping, medical records; identifying quality issues and monitoring, implementing and tracking interventions; performing oversight of delegated organizations; and ensuring compliance with Plan, State and Federal requirements.

JOB REQUIREMENTS:

•Registered Nurse (RN) with unrestricted license in state.
•3 years clinical experience.
•2 years' experience in utilization review, quality assurance, and/or medical record and site review audits.
•Knowledge of medical terminology standard medical practices, formal quality improvement process, and federal, state, accreditation regulations and standards.
•Verbal and written communications skills including interpersonal skills for meeting with physicians and office staff and representing the company using diplomatic/professional demeanor.
•PC proficiency to include Word and Excel.
• Willing to travel, including infrequent overnight stays.

PREFERRED JOB REQUIREMENTS:

•Certified Professional in Healthcare Quality (CPHQ).
•1 year HEDIS abstraction experience.
•Experience in systems database.
•Experience designing and delivering presentations.
•Experience delivering member and/or provider training.

•This position will be based out of Albuquerque, New Mexico.

•CA
•CB

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Requirements: Expertise Nursing Job Type Full-Time Regular Location NM - Albuquerque


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