HEDIS Quality Audit specialist

Pay Range

$105.00/hr - $120 Σ/hr

Nashville, TN (100% remote). Candidates from Illinois, Tennessee, Montana, New Mexico, Oklahoma, and Texas are eligible.

12+ months (temp to hire)

ASAP

• Evaluates clinical service requests made by members and providers, using clinical judgment and organizational criteria.
• Participates in the assessment of clinical service requests and the Physician Review Unit appeal process of service denials.
• Practices anticipatory case management for members whose cases come for review, in partnership with case managers.
• Contributes to the development of Physician Review Unit policies and procedures.
• Actively participates in continuous quality improvement activities within the unit.
• Performs other duties as assigned by the Medical Director.

• Board Certified SchnABMS M.D. or D.O., unrestricted and active license to practice medicine.
• At least 5 years of clinical experience, including inpatient experience, or an equivalent combination of education and experience.
• Understanding of managed care and expertise in PC proficiency (file review will be conducted via computer).
• Position does not provide direct patient care or medical diagnosis.
• Medical Director candidate must reside in Tennessee, Illinois, Montana, New Mexico, Oklahoma, or Texas.

Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.

Best Regards,

Ankit Mishra

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