Florida Licensed Clinical Auditor

Job Summary

To support healthcare services, the full-time Florida Licensed Clinical Auditor will perform clinical audits for compliance with regulatory requirements, focusing on quality member care and outcomes.

Key responsibilities

• Conducts audits in utilization management, care management, and behavioral health to ensure compliance with guidelines
• Identifies clinical gaps in care and assesses clinical decision-making among staff, reporting findings to leadership
• Maintains detailed records of auditing results and assists in developing training materials based on audit outcomes

Required qualifications

• At least 2 years of healthcare experience, including 1 year in utilization management or care management
• Active Registered Nurse (RN) license in the state of practice
• Proficiency in Microsoft Office and applicable software programs
• Strong analytical skills and attention to detail
• Ability to work collaboratively in a cross-functional environment