Clinical Quality Assurance Auditor - Knoxville

Job Responsibilities

• 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

Job Qualifications

• Education: Bachelor's Degree in Health Care related field or equivalent work experience
• Experience: 4 years - Health Care experience required. 1 year - Managed care experience or experience with Quality Medical Record Review

Skills & Certifications

• Demonstrated presentation and team facilitation skills
• Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
• Excellent oral and written communication skills
• Excellent time and project management skills
• Strong analytical, planning, organizational and research skills

License

• Registered Nurse (RN) with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law.

Company Information

• Company: BCBST BlueCross BlueShield of Tennessee, Inc.