Clinical Intelligence Quality Auditor – Contract

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct assigned clinical audits in accordance with approved sampling, methodology, documentation, quality standards, and turnaround time requirements.

• Analyze clinical indicators and document classifications, summaries, assessments, recommendations, and other designated clinical intelligence outputs.

• Evaluate the accuracy, completeness, clinical support, contextual relevance, and appropriateness of outputs for the intended workflow.

• Identify and escalate missing, conflicting, outdated, or unsupported information, along with potential safety concerns.

• Record findings utilizing approved audit definitions, error taxonomy, and severity classifications.

• Raise potential patient safety issues, unsupported adverse outputs, recurring error trends, and ambiguous standards.

• Assist with temporary surges in audit or surveillance activities due to launches, remediation efforts, client issues, performance changes, or solution updates.

• Engage in clinical reviewer calibration and integrate feedback received.

• Uphold confidentiality, reliability, and timely communication.

• Communicate constraints in workload, case complexity, and potential delays for effective capacity planning.

• Consistently apply approved audit methodology across designated solutions and clinical domains.

• Ensure traceable documentation is maintained for quality reviews, trend reporting, and governance decisions.

• Differentiate clinical intelligence performance issues from concerns related to documentation, workflow, education, and data availability.

• Participate in secondary review or quality checks upon request.

• Provide insights to enhance audit definitions, reviewer guidance, or escalation processes.

• Carry out objective clinical findings while governance leadership maintains accountability for methodology, risk thresholds, and portfolio-level decisions.

• Escalate cases needing further clinical or governance judgment rather than making independent decisions regarding launches, pauses, or remediation.

• Collaborate with clinical quality specialists and reviewers to ensure consistent interpretation of audit definitions and severity classifications.

• Deliver findings that support Product, Data Science, and Clinical Programs.

• Maintain objectivity and consistently document both favorable and unfavorable findings.

⛳️ Requirements

• An active and unrestricted clinical license as a registered nurse, occupational therapist, physical therapist, or other relevant discipline for assigned clinical reviews.

• Registered nurse is preferred due to the extensive nature of the current portfolio.

• A minimum of three years of experience in post-acute care, utilization management, care management, clinical documentation review, clinical quality, or a related healthcare setting.

• Strong skills in medical record review and post-acute clinical judgment.

• Ability to apply structured audit guidance consistently.

• Experience in reviewing longitudinal medical records and synthesizing information across various clinical document types or care settings.

• Ability to differentiate significant clinical issues from minor documentation variations and articulate potential downstream impacts.

• Capability to work independently, meet deadlines, document concise findings, and appropriately escalate uncertainties or concerns.

• Availability for approximately 20 hours per week during the initial six-month engagement.

• Preferred: experience with skilled nursing, home health, care transitions, prior authorization, continued stay, or level-of-care reviews.

• Preferred: background in health plans, delegated utilization management, clinical criteria, or authorization review.

• Preferred: experience with clinical abstraction, informatics, clinical decision-support validation, healthcare quality assurance, or performance monitoring.

• Preferred: familiarity with evaluating clinical intelligence, AI-enabled healthcare tools, NLP-generated content, predictive analytics, or other technology-supported clinical outputs.

• Preferred: experience collaborating with healthcare technology, Product, Data Science, or clinical informatics teams.

• Preferred: knowledge of agreement, sensitivity, specificity, false-positive and false-negative patterns, and error severity.

🏝️ Benefits

• Flexible clinical review capacity within a contractual engagement.

• Initial six-month contract engagement.

• Approximately 20 hours per week commitment.

• Possibility of contract extension or expansion based on business requirements, workload, and performance.

• Consideration for future full-time opportunities (conversion is not guaranteed).

• Reasonable accommodations provided during the selection and engagement process.