Clinical Quality Auditor, Consultant

Your Role

The Quality Review team completes audits of front-line staff to ensure alignment with department processes and regulatory compliance. Clinical Quality Auditors also provide coaching and work closely with business leaders to drive optimal results. The Clinical Quality Auditor, Consultant will report to the Quality Review Senior Manager. In this role you will develop performance metrics, evaluate performance, and provide coaching to ensure that staff have the skills and knowledge required to be successful in Population Health Management and Utilization Management.

Your Knowledge and Experience

• Current California RN or NP license required
• A college degree or equivalent experience and minimum 7 years of prior relevant experience required
• At least 7 years of experience in managed care or similar complex healthcare environment with a minimum of 1 year experience in Case Management required
• Auditing experience preferred
• Population Health Management and Utilization Management experience preferred
• Strong organizational and/or project management skills to coordinate departmental projects and to perform multiple projects or tasks simultaneously
• Subject matter expert with capability to effectively audit and train all lines of business (Commercial, Federal Employee Program, Medicare, and Medi-Cal)

Pay Range

The pay range for this role is: $ 109340.00 to $ 164120.00 for California.

Note

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.