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Clinical Quality Assurance Auditor
BlueCross BlueShield of TennesseeClinical Quality Assurance Auditor conducting reviews and audits for healthcare providers to ensure compliance with quality standards. Utilizing analytical skills to improve healthcare processes and outcomes for BCBST.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in clinical audit processes, including HEDIS and STARS data collection, while ensuring compliance with national accreditation standards. Strong analytical and communication skills are essential for identifying trends and improving quality of care.
Highest-signal resume keywords
Registered Nurse (RN)HEDIS Data CollectionSTARS Data CollectionQuality Medical Record ReviewAnalytical Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
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Hard Skills
Clinical AuditData AnalysisQuality ImprovementCompliance AuditsMedical Record Review
Soft Skills
Oral CommunicationWritten Communication
Tools & Technologies
Microsoft Office
Certifications & Qualifications
Active Tennessee RN LicenseNurse Licensure Compact License
Industry Keywords
Healthcare ExperienceManaged CareQuality of CareAccreditation StandardsRegulatory Agency Requirements
About the role
Key responsibilities & impact- Presenting and communicating audit results to appropriate parties; participates in the development of procedures and standards that support and enhance all lines of business' quality of care goals.
- Schedule and perform routine facility, practitioner site, and medical record reviews, utilizing established clinical audit tools reflective of national accreditation standards and regulatory agency requirements.
- Identifying and evaluating areas of exposure, potential problems and liabilities.
- Analyze clinical data to improve individual provider compliance with education; provide oversight for regional contract staff and coordinate the effort of retrieval of HEDIS and/or STARS records; complete medical record audits for HEDIS and/or STARS data collection or quality of care reviews as required.
- Providing required documents and consulting support for quality and compliance audits.
Requirements
What you’ll need- Registered Nurse (RN) with an active Tennessee license or a license from a Nurse Licensure Compact state.
- 4 years of healthcare experience.
- 1 year of managed care experience or experience with Quality Medical Record Review.
- Experience with HEDIS and/or STARS data collection.
- Strong analytical skills with the ability to identify trends and recommend process improvements.
- Excellent oral and written communication skills.
- Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint).
Benefits
Comp & perks- Various immunizations and/or associated medical tests may be required for this position.
- Relocation assistance may be available for eligible candidates residing in Chattanooga, TN.