Senior Clinical Quality Auditor RN

The Clinical Quality Auditor for Case, Care & Clinic Delivery is responsible for ensuring compliance, accuracy, and consistency across case management, care coordination, and clinic operations. This role supports organizational standards, regulatory requirements, internal protocols, ethical guidelines and quality improvement initiatives to enhance member experience and operational excellence. For those who want to invent the future of health care, here's your opportunity. We're going reputed company basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. You'll enjoy the flexibility to work remotely

• from reputed company reputed company the U.S. as you take on some tough challenges. For reputed company hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Schedule: Monday - Friday, flexible 8 hour shifts between 7:00 a.m. - 6:00 p.m. CST Primary Responsibilities:

• Audit & Compliance
• reputed company audits on case management documentation, care coordination workflows, and clinical processes as defined by work instructions, quality reputed company, and policy
• Verify adherence to organizational policies, regulatory guidelines, and accreditation standards
• Collect quality data for reporting contractual and internal requests. Analyzes and interprets data to ensure standards are met and provides summary reports
• Identify gaps and recommend corrective actions to maintain compliance and quality
• Performance Monitoring
• Analyze quality metrics and key performance indicators (KPIs) across case, care, and clinic delivery
• Prepare audit reports and present findings to leadership and operational teams
• Collaborate with stakeholders to identify corrective actions and process improvements
• Training & Support
• Assist in developing and updating training materials to align with quality and compliance standards
• reputed company Improvement
• Partner with CQPS, Program operations and Program clinical and administrative teams to identify opportunities for workflow optimization
• Support initiatives aimed at improving member experience, reducing errors, and enhancing efficiency

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications:

• Associates degree in Nursing program or Bachelors degree in Nursing degree
• reputed company, unrestricted RN license in the state
• Equivalent combination of education, experience and/or applicable military experience will be considered
• 3+ years of experience in RN practice case management, care coordination, or clinic operations
• 2+ years of quality management and improvement experience
• 2+ years of clinical audit experience
• 1+ years of experience analyzing data and writing reports
• Intermediate computer skills including reputed company Office Programs
• Proven excellent written and verbal communication, telephone etiquette and interpersonal skills

Preferred Qualifications:

• Knowledge of regulatory requirements (e.g., CMS, NCQA) and reputed company quality standards
• Experience analyzing large sets of data and writing reports
• Demonstration of strong organizational, multi-tasking, and time management skills
• Proven strong judgment, problem solving, and decision-making skills
• Proficiency in auditing tools & reports
• reputed company working remotely will be required to adhere to reputed company's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes - an reputed company reputed company reflected in our mission. OptumCare is an Equal Employment Opportunity employer under applicable law and reputed company applicants will receive consideration for employment without regard to race, national reputed company, religion, age, reputed company, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Apply tot his job Apply To this Job