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Clinical Quality Auditor, Clinical Programs
Brighton Health Plan SolutionsUnited Statesfull_timeVerifiedPosted 29 Jul 2024
💰 $90,000/yr($80,000/yr – $90,000/yr)
About the role
About The Role
The Clinical Quality Auditor (CQA) will conduct audits and perform compliance/accreditation related functions. As a Clinical Quality Auditor, the CQA supports quality projects and assists with internal initiatives to ensure compliance across the clinical programs. The ideal candidate will have clinical program operational experience, as well as quality and accreditation (URAC/NCQA) expertise.
Primary Responsibilities
At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion, and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all your unique abilities.
Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today’s healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes, and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today’s challenges into tomorrow’s solutions.
Come be a part of the Brightest Ideas in Healthcare™.
The Clinical Quality Auditor (CQA) will conduct audits and perform compliance/accreditation related functions. As a Clinical Quality Auditor, the CQA supports quality projects and assists with internal initiatives to ensure compliance across the clinical programs. The ideal candidate will have clinical program operational experience, as well as quality and accreditation (URAC/NCQA) expertise.
Primary Responsibilities
- Reporting to the Clinical Programs Manager, will also collaborate with Clinical Program leaders to support quality initiatives, address clinical process gaps, and monitor corrective action plans.
- Conducts clinical quality audits (UM/CM)
- Support gap analyses and assist with creation of corrective action plans (CAPs)
- Conduct accreditation and regulatory review of training curricula as assigned
- Provide project specific compliance support as assigned (workflow creation, accreditation question research and answer, audit analysis report outs to leader)
- Support the clinical team with staff onboarding
- Participate in the development, implementation, and evaluation of corrective and preventative action plans to address deficiencies and promote process improvement
- Assist with development, delivery, and documentation of training
- Participate in accreditation audit readiness and/or compliance and training to include mock audits
- Assist with process improvement initiatives
- Maintain electronic files that can be accessed by appropriate personnel
- Communicate effectively and objectively; provide constructive feedback and comments
- Write documents including but not limited to audit documents, agendas, meeting minutes and support documents for processes and compliance initiatives
- Assist with development and analysis of regulatory reporting to support accreditation including preparation and presentation of audit files as required.
- Other assigned duties as required
- Active and unrestricted license as a Registered Nurse (RN)
- Bachelor’s degree in nursing, (or equivalent experience within managed care environment)
- Certified Professional Healthcare Quality (CPHQ) certification (or willing to obtain within 6 months of hire)
- Experience with accreditation bodies (URAC/NCQA)
- Organized with the ability to define and solve problems, collect data, establish facts, follow-up, and make decisions for current and future needs.
- Highly motivated, takes initiative with ability to meet objectives and function with high degree of independence
- Fearless communicator and team player
- Must be detail oriented and have strong organizational and time management skills, and the ability to work independently
- Proficient in Microsoft Word, Excel and Outlook.
At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion, and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all your unique abilities.
Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today’s healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes, and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today’s challenges into tomorrow’s solutions.
Come be a part of the Brightest Ideas in Healthcare™.
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