Clinical Quality Assurance Auditor

Role Overview

• Play a critical role in ensuring members receive high‑quality care by reviewing network providers for compliance.
• Work from home while traveling throughout the Jackson region to conduct on‑site provider reviews.
• Independently schedule and perform multiple types of reviews using established audit tools.
• Communicate findings and outcomes directly with providers and office staff.
• Support the annual HEDIS project by collecting medical records for hybrid reviews.

Requirements

• Bachelor's Degree in Health Care related field or equivalent work experience.
• 4 years
• Health Care experience required.
• 1 year
• Managed care experience or experience with Quality Medical Record Review.
• Demonstrated presentation and team facilitation skills.
• Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint).
• Excellent oral and written communication skills.
• Excellent time and project management skills.
• Strong analytical, planning, organizational and research skills.
• Registered Nurse (RN) with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law.

Benefits

• Various immunizations and/or associated medical tests may be required for this position.