Top 10 Clinical auditor Jobs in Columbus

Sr Quality Improvement/HEDIS Spec, Health Plan Interventions (Remote In Ohio)
Molina Healthcare —Columbus, OH
- $54,922 - $107,099 a year
- Full-time
- Remote
- RN License
- Writing skills
- Analysis skills
- Health insurance
Clinical Review Nurse Supervisor (Medicaid Health Systems Administrator 1)
State of Ohio - Medicaid —Columbus, OH
- $40.40 an hour
- Full-time
- Nursing
- RN License
- Mid-level
- Paid holidays
- Health insurance
4d
Full-Time Home Health OASIS Auditor (HCS-O or COS-C )
National Church Residences —Dublin, OH
- Full-time
- Nursing
- Microsoft Excel
- Microsoft Outlook
Quick Apply
Compliance Educator
Nationwide Children's Hospital —Columbus, OH
- Full-time
- Hybrid work
- Nursing
- RN License
- Public speaking
VRCC Director, Business Office
SUN Behavioral Health —Columbus, OH
- Full-time
- HIPAA
- Office
- High school diploma or GED
Chief Financial Officer
Council Capital —Dublin, OH
- Full-time
- Hybrid work
- CPA
- Office
- GAAP
8d
Senior Accountant
Madison County Hospital —London, OH
- Full-time
- 7 years
- CPA
- Computer literacy
- Paid holidays
- Health insurance
Quick Apply

More jobs to discover

Find similar jobs that you might be interested in.

Clinical Review Nurse Supervisor (Medicaid Health Systems Administrator 1)
State of Ohio - Medicaid —Columbus, OH
Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence. Exp. in the delivery of a health services program or…
$40.40 an hour
4d

Explore jobs in cities nearby

Check out jobs in cities near your current location, Columbus

Sr Quality Improvement/HEDIS Spec, Health Plan Interventions (Remote In Ohio)
Molina Healthcare —Columbus, OH
If licensed, license must be active and unrestricted in state of practice. Implements evidence-based and data-informed key member intervention strategies…
$54,922 - $107,099 a year
Clinical Review Nurse Supervisor (Medicaid Health Systems Administrator 1)
State of Ohio - Medicaid —Columbus, OH
Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence. Exp. in the delivery of a health services program or…
$40.40 an hour
4d

Show more jobs in cities nearby

I want to receive the latest job alert for clinical auditor in columbus

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

clinical auditor jobs near columbus

Quality Improvement Specialist jobs in Columbus, OH

Business Office Director jobs in Columbus, OH

Educator jobs in Columbus, OH

Systems Administrator jobs in Columbus, OH

Quality Assurance Aba jobs in New York, NY

Quality Improvement Specialist jobs in Detroit, MI

Food Quality Assurance jobs in San Diego, CA

Quality Improvement Specialist jobs in Remote

Quality Improvement Specialist jobs in Brooklyn, NY

Quality Assurance jobs in Utah

Quality Improvement Specialist jobs in Fort Worth, TX

Chief Financial Officer jobs in Burbank, CA

Chief Financial Officer jobs in Harrisonburg, VA

Entry Level Financial Advisor jobs in Jacksonville, FL

Security Officer jobs in Albuquerque, NM

Chief Financial Officer jobs in Sarasota, FL

Senior Financial Analyst jobs in Atlanta, GA

Chief Financial Officer jobs in Akron, OH

Security Officer jobs in Gainesville, FL

Office Clerk jobs in Bakersfield, CA

Sr Quality Improvement/HEDIS Spec, Health Plan Interventions (Remote In Ohio)

Molina Healthcare -
Columbus, OH

Apply Now

Job Details

Full-time
$54,922 - $107,099 a year

Benefits

Health insurance

Qualifications

Managed care
Managed care organization experience
Writing skills
Clinical program data analysis
Productivity software
Clinical data analysis

Full Job Description

Molina Healthcare of Ohio is hiring for a Sr Quality Improvement/HEDIS Specialist on our Health Plan Community Interventions team.
This role is remote however candidates must live in Ohio.

This role is laser focused on Quality Improvement using QI Science. This role will be assigned a primary population stream and will be expected to support improvement work for Medicare Stars Measures.

Highly qualified candidates will have the following experience-

Using the specific models for improvement required by the state of Ohio
Experience with a formal model like IHI or Lean or Six Sigma, Green or Yellow Belt Improvement
Power BI is helpful but expert level is not required
Familiarity with Medicare (Ideally the Duals population)
Familiarity with QI Science, Health Equity, Population Health, Health Management

This role also provides senior level support for clinical quality member intervention activities. Responsible for the developing and implementing new and existing member intervention initiatives including all lines of business (Medicare, Marketplace, Medicaid, etc.). Executes health plan member and community quality-focused interventions and programs in accordance with established program standards, and federal/state/National Committee for Quality Assurance (NCQA) regulations. Conducts data collection, monitors intervention activity including key performance measurement activities, reports intervention outcomes, and supports continuous improvement of intervention processes and outcomes.

Essential Job Duties

Implements evidence-based and data-informed key member intervention strategies including initiating and managing member and/or community interventions (e.g., removing barriers to care) and other federal and state quality initiatives.
Monitors and ensures that key member intervention activities are completed on time and accurately, and presents results to key departmental management and other applicable Molina departments.
Writes narrative reports to interpret regulatory specifications, explains programs and results of programs, and documents findings and limitations of department interventions.
Creates, manages, and/or compiles required documentation necessary to maintain critical program milestones, deadlines, and deliverables.
Participates in quality improvement (QI) activities, meetings, and discussions with and between other departments within the organization.
Supports provision of high-quality clinical care and services by facilitating/building strategic relationships with community-based organizations (CBOs).
Evaluates quality project/program activities and results to identify opportunities for improvement.
Raises gaps in processes that may require remediation to quality leadership.
Provides support for quality-related projects.
Provides training and support to new and existing quality member interventions team members.
Demonstrates flexibility when it comes to change management and maintains a positive outlook.
This position may require same day out of office travel 0 - 80% of the time, depending upon state-specific needs.
This position may require multi-day overnight travel on occasion, depending upon state-specific needs.

Required Qualifications

At least 3 years of experience in health care, and at least 2 years of experience in health plan quality member interventions in a managed care setting, or equivalent combination of relevant education and experience.
Demonstrated solid business writing experience.
Proficiency with data analysis, manipulation and interpretation.
Intermediate knowledge and understanding of HEDIS and NCQA.
Critical-thinking, problem-solving and analytical skills.
Attention to detail and organizational skills.
Ability to navigate change with flexibility and a positive outlook.
Ability to work independently in a fast-paced, deadline-driven environment.
Effective verbal and written communication skills.
Microsoft Office suite and applicable software programs proficiency, and ability to learn new information systems and software programs.

Preferred Qualifications

Experience with data reporting, analysis, and interpretation.
Experience with Medicaid, Medicare, and/or Marketplace government-sponsored programs.
Certified Professional in Health Quality (CPHQ).
Certified HEDIS Compliance Auditor (CHCA).

Registered Nurse (RN). If licensed, license must be active and unrestricted in state of practice.
*

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $54,922 - $107,099 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Apply Now

Refine Your Search

clinical auditor jobs in columbus

Sr Quality Improvement/HEDIS Spec, Health Plan Interventions (Remote In Ohio)

Clinical Review Nurse Supervisor (Medicaid Health Systems Administrator 1)

Full-Time Home Health OASIS Auditor (HCS-O or COS-C )

Compliance Educator

VRCC Director, Business Office

Chief Financial Officer

Senior Accountant

More jobs to discover

Explore jobs in cities nearby

I want to receive the latest job alert for clinical auditor in columbus

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected