Clinical Process Improvement Specialist - Audit

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Job Summary
This position will serve as the audit lead and SME, will lead external consultant audits, interact with all relevant matrix partners, create and implement audit action plans in collaboration with multiple areas, develop audit-related content, and participate in quality initiatives. This will be a client-facing role with primary responsibilities of researching audit cases, preparing case templates, and presenting cases in clinical audits to consultants and/or clients. This position is responsible for developing and evaluating clinical business processes to support the cost of care, quality, compliance and financial performance strategy for the divisional/enterprise care management operations. Responsible for providing independent, objective evaluation and consultative services that enhance business performance, minimize risk and optimize care management programs/services/interventions. Collaborate with clinical operations management, EHCM Learning and Development, and Culture and Engagement teams in identification and implementation of best cost of care management practices. Develop methodologies and tools to monitor performance and prepare Executive Summaries. Exceptional verbal and written communication. Intermediate to expert knowledge of PPT, Excel, Word, Outlook and other Microsoft Office tools.
**This is a Telecommuter position and can be located in IL, MT, NM, OK, or TX**
JOB REQUIREMENTS:

• Registered Nurse (RN) with current, unrestricted clinical license to practice in state of operations.
• 2 years clinical experience.
• 1 year clinical auditing or managed care experience.
• Knowledge of managed care operations.
• Analytical skills to effectively identify improvement opportunities and root cause.
• Verbal and written communication skills to work across the division, collaborate with management, develop executive summaries.
• PC experience utilizing Microsoft Office software.

PREFERRED JOB REQUIREMENTS:

• Bachelor Degree in Nursing or Health Administration or in the healthcare field.
• Managed care experience with working knowledge of managed care and UM/CM policies and practices.
• Case Management experience.
• Disease Management experience.
• Health insurance experience.
• Auditing experience.
• Certified Professional Health Care Quality (CPHQ Certification).
• Ability to travel including overnight stays, as needed.

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HCSC Employment Statement:
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.