Government Programs Quality Auditor

3 days ago


Baltimore, Maryland, United States CareFirst Full time
About the Opportunity

CareFirst is seeking a highly skilled Government Programs Quality Auditor to join our team. This role plays a critical part in evaluating clinical quality and procedures within our Government Programs, ensuring compliance with regulatory standards.

Responsibilities
  • Evaluate clinical appeals and grievance letters/documentation for accuracy and completeness
  • Analyze data to identify areas for improvement and develop strategies to enhance quality metrics
  • Collaborate with cross-functional teams to develop education resources and training programs
  • Establish effective partnerships with other business units to drive quality initiatives
Requirements
  • Bachelor's Degree in Nursing or equivalent experience
  • 5 years of clinical nursing experience, including 3 years of quality auditing and improvement
  • Strong analytical and problem-solving skills, with ability to communicate complex information effectively
  • Experience working with government programs, utilization management, and managed care preferred
Estimated Salary

$94,516 per year



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