New

Quality Improvement Auditor (Clinical)

Spectraforce Technologies

United States, Arizona, Maricopa

May 14, 2025

Job Title: Quality Improvement Auditor (Clinical)

Job Location: Remote in AZ (Maricopa - Pima preferred (may need to travel further, but the manager will try to keep it within their area)) About 10% of the job requires travel to the provider location (on rotation with advanced notice)

Job Duration: 03 Months (Possibility to extend and convert to FTE)

Shift: 8 hr days, Mon-Fri 8 am-5 pm AZ time (some flexibility upon approval from supervisor).

Position Purpose: Lead medical record audits, monitor and analyze clinical documentation, and modify business processes to measure member outcomes. Assess provider performance and quality of care through clinical case reviews.

Education/Experience: Bachelor's degree in Nursing, related field or equivalent experience. 3+ years of nursing or quality improvement experience.

Licenses/Certifications: Current state's RN license.

* 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

QOC is a fairly autonomous group with most roles being Licensed nurses or social workers
Open communication via Teams and weekly structured meetings in addition to regular Team Building
Team is responsible for reviewing Incident, Accident, and Death (IAD) reports submitted in the Medicaid/AHCCCS portal for our members.
If the IAD indicates and adverse outcome or possibility of adverse outcome, we investigate the allegations to determine if the provider is providing the appropriate care.
?The investigator may use all available resources, including medical records, policy, best practices, and AZ statutes, researching these areas when appropriate for the case.
This position will be assigned cases and will carry their own caseload, tracking due dates of 30-60 dates from the date assigned, to ensure timely completion and submission of investigation to AHCCCS

?Must haves: Current AZ License and Bx Health experience

Nice to haves: Quality Experience

Candidate Requirements
Education/Certification	2+ years clinical, quality management or healthcare related experience. At least one year experience in quality function in a healthcare setting.	Preferred: Master in BH
Licensure	Required: i.e RN, BSN, LPN, etc.	Preferred: Licensure through AZ Board of Bx Health (Social worker or counselor)