Quality Improvement Auditor - REMOTE

Quality Improvement Auditor - Fully Remote

The Quality Improvement Auditor will lead medical record audits, monitor and analyze clinical documentation, and modify business processes to measure member outcomes. This role involves assessing provider performance and quality of care through clinical case reviews.

Responsibilities

• Lead clinical audits for provider medical records both remotely via electronic medical records and on-site to assess performance, determine trends, and compile written reports summarizing findings, including clinical recommendations to assure the delivery of quality services.
• Lead case reviews to assess the clinical performance provided in the provider network, including written clinical summaries and recommendations.
• Perform ongoing quantitative and statistical analysis of the business unit's performance data to include various contracted performance measures, service utilization, and member/provider complaint and quality of care trends.
• Coordinate with internal teams to assure audit requests are fully understood, accurately compiled, and delivered timely.
• Perform other performance and process improvement activities.
• Comply with all policies and standards.

Essential Skills

• Active LPN or RN license in GA and/or compact states in the EST time zone.
• Bachelor's degree in nursing, a related field, or equivalent experience with a clinical license.
• 3+ years of quality improvement experience or similar to Quality Improvement Auditor.
• Audit experience, including writing and reporting in a clinical setting.
• Compliance and investigation experience.

Additional Skills & Qualifications

• 3+ years of experience in nursing and quality improvement.
• Preferred knowledge of the QOC investigation process.
• Clear and concise writing skills.
• Must be located in GA or EST states.

Work Environment

The role involves training from 8 am to 5 pm EST, Monday to Friday, with no overtime. Initially, there will be an IT call on Day 1 followed by compliance training. After lunch, the shift starts at 1 PM. The standard working hours are 8 am to 5 pm EST, Monday to Friday.

Job Type & Location

This is a contract position based out of Atlanta, Georgia.

Pay and Benefits

The pay range for this position is $30.00 - $33.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:

Medical, dental & vision Critical Illness, Accident, and Hospital 401(k) Retirement Plan Pre-tax and Roth post-tax contributions available Life Insurance (Voluntary Life & AD&D for the employee and dependents) Short and long-term disability Health Spending Account (HSA) Transportation benefits Employee Assistance Program Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a fully remote position.

Application Deadline

This position is anticipated to close on Oct 20, 2025.