Case Auditor
Core
Conduct detailed audits of care management records, documentation, and workflows to ensure accuracy, consistency, and regulatory compliance in a healthcare environment.
Role type
Healthcare case auditor (compliance & quality assurance)
Builds
Audit reports, corrective action plans, and updated care management policies
Domain
Healthcare / Regulatory Compliance
Deliverable
dashboards & analysis
Required skills
Healthcare auditing, case management, quality assurance, regulatory compliance, data analysis, report writing, risk assessment
Preferred skills
NCQA standards, HEDIS, CMS guidelines, audit tool development, staff training
Responsibilities
Conduct regular audits of care management records and workflows; Review cases for accuracy and adherence to healthcare quality standards; Identify trends, discrepancies, and potential risks; Develop and maintain audit tools and tracking systems; Collaborate with leadership to implement corrective action plans; Prepare audit reports and communicate findings to management; Monitor process changes to ensure sustained compliance improvements.