Location: The territory for this position is the State of Louisiana.
The Clinical Quality Auditor Sr. is responsible for ensuring clinical quality through an audit process.
How you will make an impact:
Conducts on-site audits of prospective and existing physicians and independent practice groups.
Ensures that both utilization and quality programs meet criteria.
Collects and analyzes data to formulate recommendations and solutions based on audit trends and results.
Compiles and maintains statistical data.
Prepares reports for management that define and evaluate problems and propose solutions.
Minimum Requirements: Requires BS in nursing, health sciences, health management or a related clinical field and minimum of 5 years of experience in utilization management, quality assurance and/or plan administration; or any combination of education and experience, which would provide an equivalent background. Current unrestricted RN license in applicable state(s) required.
Preferred Skills, Capabilities & Experiences: As required by the State of Louisiana, the selected candidate must be a LCSW, LHMP, or Psychologist.
