Job Description

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Case Auditor based in the United States. This remote role focuses on ensuring accuracy, consistency, and regulatory compliance across care management operations. You will conduct detailed audits of case records, documentation, workflows, and processes to identify gaps and areas of risk. Your findings will help strengthen quality, improve operational processes, and support member-centered care. You will work closely with care management leaders to develop corrective actions and monitor their effectiveness over time. The role combines auditing, compliance, data analysis, reporting, and staff support in a healthcare environment. You will also contribute to training and continuous improvement initiatives informed by audit results and performance trends. Candidates must reside in Oklahoma and be available Monday through Friday, from 8:00 AM to 5:00 PM. Accountabilities - Conduct regular audits of care management records, documentation, and workflows to assess compliance with internal policies, NCQA standards, and applicable regulatory requirements. - Review cases for accuracy, consistency, completeness, and adherence to healthcare quality and compliance standards. - Identify trends, discrepancies, documentation gaps, and potential risks, providing clear and actionable recommendations to leadership. - Develop and maintain audit tools, scorecards, tracking systems, and review methodologies that support consistent and objective evaluations. - Collaborate with care management leadership to address audit findings and develop or implement corrective action plans. - Support the development and updating of care management policies, procedures, and training materials based on audit results. - Monitor process changes and corrective actions to assess whether improvements are sustained and compliance objectives are achieved. - Provide guidance and feedback to care management leadership regarding documentation requirements, best practices, and quality standards.

- Participate in training and staff education initiatives focused on compliance, documentation, and care management excellence. - Prepare audit reports and communicate findings, trends, performance metrics, and recommendations to management. - Track compliance trends and improvement initiatives to evaluate program effectiveness and support data-informed decision-making. - Work collaboratively with internal leadership and participate in internal or external audits when required. - Follow organizational policies, standards, and procedures and perform other related duties as assigned. Requirements - High school diploma or GED required. - 2–4 years of relevant professional experience required. - Vocational or technical education and additional on-the-job or continuing education may be applicable. - Experience with healthcare auditing, case management, quality assurance, or regulatory compliance is preferred. - Familiarity with NCQA, HEDIS, CMS, state healthcare guidelines, and related regulatory or accreditation requirements is highly desirable. - Strong computer skills and the ability to work effectively with audit tools, documentation systems, tracking platforms, and data. - Excellent written and verbal communication skills, with the ability to present findings and recommendations clearly. - Strong customer-service, organizational, analytical, and time-management skills. - High attention to detail and the ability to identify inconsistencies, assess risk, and translate findings into practical improvements. - Ability to manage multiple priorities, meet deadlines, work independently in a remote environment, and collaborate effectively with leadership and care management teams. - Oklahoma residency is required for this fully remote position.

Job Tags

Similar Jobs