Case Auditor
Core
Conduct comprehensive audits of care management activities, documentation, and processes to ensure accuracy, consistency, and compliance with regulatory standards (NCQA, CMS, HEDIS).
Role type
Case Auditor (Healthcare Operations)
Builds
Audit tools, scorecards, tracking systems, and corrective action plans
Domain
Healthcare / Care Management / Regulatory Compliance
Deliverable
dashboards & analysis
Required skills
Auditing, case management, regulatory compliance (NCQA, CMS, HEDIS), data analysis, report writing
Preferred skills
Vocational or technical education in healthcare, computer proficiency
Responsibilities
Conduct regular audits of care management records and workflows; Identify trends, discrepancies, or potential areas of risk; Develop and maintain audit tools and tracking systems; Collaborate with leadership to implement corrective action plans; Prepare audit reports and present findings to management; Track performance metrics and compliance trends.
Seniority
Mid-level (2-4 years experience)