Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier.
By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.
At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.
If this sounds like you, read on!
The Clinical QA Auditor will effectively perform reviews of case management data submitted to DMAS by VA Premier’s Regulatory Reporting to ensure the accuracy of the data reported and conducting member chart audits to ensure that VA Premier’s electronic medical records are complete and in compliance with internal policies and procedures, Federal, State, local and regulatory laws/agencies. The Clinical QA Auditor will work closely with Regulatory Reporting and with the Medical Management’s Case Management/Care Coordination teams to assist in establishing an oversight framework for the Health Plan.
Our Medical Management department educates members and empowers them to become active participants in their coordinated health care plans. This team of knowledgeable professionals in their field provide services to include Utilization Review, Medical Outreach, Case Management, Disease Management, Credentialing, Social Work as well as Grievance and Appeals.
MINIMUM EDUCATION REQUIREMENTS
SPECIAL KNOWLEDGE AND/OR SKILLS
WORK BACKGROUND EXPERIENCE
All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE