Clinical Quality Specialist


Rancho Cordova, CA

What you'll be doing

Performs quality audits of clinical functions. Analyzes performance data to evaluate the efficiency and effectiveness of clinical processes. Works with clinical business units to develop and implement preventive or corrective action to remedy or prevent performance failures. Tracks quality improvement activities, assesses trends and provides reporting to various departments and committees. Reviews and assesses the documentation used in clinical business units to ensure compliance with the control of documentation requirement. Facilitates process improvement in clinical business units. Performs all other duties as assigned by management.

What your background should be

Minimum three years managed care experience. Must have and maintain current, valid and unrestricted clinical license. Demonstrated ability through qualified clinical medical experience to assess, evaluate and interpret medical information to appropriately triage the request for services. Must have advanced PC skills, especially with medical data entry systems, Excel, Word, internet and email. Excellent oral and written communication skills, including ability to clearly communicate with providers and inter-company resources. Possess a high level of understanding of community resources, treatment options, home health funding options and special programs. Proficient skills in the area of CPT coding, medical terminology and ICD-9 diagnosis codes required. Exposed to confidential information and expected to maintain confidentiality at all times; must adhere to HIPAA rules and regulations.

Required Schooling / Training

Bachelor's degree in a clinical field.

Who is the client company

This is an American health care insurance provider.
If you are interested in this position, send your resume to