案例审计员
Case Auditor
职位职责：Case Auditor通过全面审核个案管理活动、文档和流程，确保护理管理运营的准确性、一致性和合规性。该职位通过识别差距、确保符合监管和认证标准（例如NCQA、CMS、HEDIS、州指南）以及推动持续改进计划，支持组织提供高质量、以会员为中心的护理。
关键信息：这是一个远程职位，但申请人必须居住在俄克拉荷马州。理想的候选人应具备审计、个案管理、NCQA、HEDIS和医疗监管要求方面的经验。候选人应具备计算机操作能力，并拥有出色的沟通、客户服务、组织和时间管理技能。工作时间为周一至周五，上午8点至下午5点。
- 审计与质量审查：
- 定期审核护理管理记录、文档和工作流程，确保符合内部政策和程序、NCQA标准及监管要求。
- 识别趋势、差异或潜在风险领域，并向管理层提供可操作的建议。
- 开发和维护审计工具、评分表和跟踪系统，以确保一致且客观的审查。
- 流程改进与合规
- 与护理管理领导合作，解决审计发现的问题并实施纠正措施计划。
- 根据审计结果和发现，协助制定和更新护理管理政策和程序以及培训材料。
- 监督流程变更的实施，确保持续合规和改善质量成果。
- 培训与支持：
- 向护理管理领导提供关于文档要求、最佳实践和质量标准的反馈和指导。
- 参与培训课程，支持员工在合规和护理管理卓越方面的持续教育。
- 报告与数据分析
- 准备审计报告并向管理层汇报发现，提供清晰的见解和建议。
- 跟踪绩效指标、合规趋势和改进计划，以衡量项目效果。协作
- 与领导紧密合作，确保审计活动与组织目标保持一致。
- 按需参与内部和外部审计。
- 完成其他指派的任务。
- 遵守所有政策和标准。
查看英文原文
Position Purpose: The Case Auditor ensures accuracy, consistency, and compliance within care management operations by conducting comprehensive audits of case management activities, documentation, and processes. This role supports the organizations mission to deliver high-quality, member-centered care by identifying gaps, ensuring adherence to regulatory and accreditation standards (e.g. NCQA, CMS, HEDIS, state guidelines), and driving continuous improvement initiatives.
Key Details:This is a remote position; however, applicants must reside in Oklahoma. The ideal candidate will have experience with auditing, case management, NCQA, HEDIS, and healthcare regulatory requirements. Candidates should be computer savvy and have excellent communication, customer service, organizational, and time-management skills. The work schedule is Monday through Friday, from 8:00 AM to 5:00 PM.
- Audit and Quality Review:
- Conduct regular audits of care management records, documentation, and workflows to ensure compliance with internal policies and procedures, NCQA standards, and regulatory requirements.
- Identify trends, discrepancies, or potential areas of risk, providing actionable recommendations to leadership.
- Develop and maintain audit tools, scorecards, and tracking systems to ensure consistent and objective reviews.
- Process Improvement & Compliance
- Collaborate with care management leadership to address audit findings and implement corrective action plans.
- Support development and updating of care management policies and procedures along with training materials based on audit results and findings.
- Monitor implementation of process changes to ensure sustained compliance and improved quality outcomes.
- Training & Support:
- Provide feedback and guidance to care management leadership on documentation requirements, best practices, and quality standards.
- Participate in training sessions to support ongoing staff education related to compliance and care management excellence.
- Reporting & Data Analysis
- Prepare audit reports and present findings to management with clear insights and recommendations.
- Track performance metrics, compliance trends, and improvement initiatives to measure program effectiveness.Collaboration
- Work closely with leadership to ensure alignment of audit activities with organizational goals.
- Participate in internal and external audits as needed.
- Performs other duties as assigned.
- Complies with all policies and standards.
Education/Experience: Requires a High School diploma or GED.
Requires 2 - 4 years of related experience. May require vocational or technical education in addition to prior work experience.
Vocation or technical education may include additional on-the-job training or continuous learning education.
Pay Range: $20.39 - $34.71 per hour
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
Originally posted on Himalayas