Texas Licensed Healthcare Auditor

Job Summary

To support healthcare services clinical auditing activities, the full-time Texas Licensed Healthcare Auditor will perform audits in utilization management and care management, ensuring compliance with regulatory requirements while working remotely.

Key responsibilities

• Conduct audits for clinical areas, monitoring compliance with NCQA, CMS, and state/federal guidelines
• Assess clinical staff decision-making and report outcomes, identifying areas for re-training
• Maintain detailed records of auditing results and assist in developing training materials based on findings

Required qualifications

• Active and unrestricted Registered Nurse (RN) license in Texas
• At least 2 years of healthcare experience, including 1 year in utilization management or care management
• Strong analytical skills and attention to detail
• Ability to work independently and as part of a team in a professional environment
• Proficiency in Microsoft Office suite and applicable software programs