Nursing - Quality Auditor Level 2

Job Title: Nursing - Quality Auditor Level 2
Location: Hopewell, NJ 08534
Duration: 5+ Months (With Possibilities of Extension)

Pay Range: $38 - $40/hr. on W2

Job Description:
This position is responsible for conducting quality audits for state audits, HEDIS, and quality referral and complaints issues. This position is also responsible for preparing weekly, monthly, quarterly, and year-end reports.
 
Responsibilities:

• Conducts on-site reviews at participating provider offices to assess environment, quality of physicians’ medical records, and compliance with documentation standards.
• Prepares appropriate documentation to summarize on-site findings with physician, providing education and discussing opportunities for improvement.
• Provides data support services to facilitate the process and analyze trends/patterns for quality improvement and health management.
• Assists the Quality Management department with various special projects and focused clinical studies.
• Performs related tasks or special studies as requested.
• Assists in training of internal Client NJ Health staff, providers, and vendors on programs and audit standards, both on and off site.
• In-house representative and project lead for state audits.
• Responsible for analysis of audit findings.
• Produces various reports as requested.
• Coordinates and manages the Corrective Action Plan (CAP) process for assigned audit type.
• Conducts re-audits ensuring prior deficiencies were addressed.

 
Qualifications:
Education/Experience:

• Requires three to five years related business experience, preferably in health care industry.
• Requires Licensed Practical Nurse License or an active New Jersey Registered Nurse License.

 
Additional Licensing, Certifications, Registrations:

• Requires valid Motor Vehicle Driver’s License and access to an automobile.

 
Knowledge:

• Requires knowledge of managed care principles.
• Requires knowledge of medical terminology.
• Requires knowledge of PCs and related software.
• Prefers knowledge of URAC accreditation standards and HEDIS principles.
• Prefers knowledge of health management or patient education.

 
Skills and Abilities:

• Requires excellent verbal and written communication skills.
• Requires excellent organization skills.
• Requires strong analytical skills.
• Requires good problem-solving/conflict resolution skills.