Medical Case Manager Auditor

Description:

The Medical Case Manager Auditor is a full-time remote role responsible for reviewing, auditing, and monitoring medical case management activities to ensure accuracy, compliance, and quality of service. This role involves evaluating case files, documentation, and workflows to confirm adherence to internal policies, payer guidelines, and applicable regulations. The Medical Case Manager Auditor will collaborate with case managers and operational teams to provide feedback, identify process gaps, and recommend improvements. Daily tasks include analyzing data and reports, preparing audit summaries, supporting corrective action plans, and contributing to training materials based on audit findings. The role also requires effective communication with leadership and stakeholders to support continuous improvement and high-quality non-clinical healthcare support services.

Qualifications

• Strong medical case management auditing skills, including reviewing documentation, verifying adherence to protocols, and assessing quality of non-clinical support services.
• Knowledge of healthcare operations, payer guidelines, regulatory requirements, and medical terminology relevant to case management and utilization review.
• Proficiency in data analysis, reporting, and use of case management or CRM software to track findings, trends, and performance metrics.
• Excellent written and verbal communication skills, with the ability to document findings clearly, provide constructive feedback, and collaborate with cross-functional teams.
• High attention to detail, strong organizational abilities, and capacity to manage multiple audits and deadlines in a remote environment.
• Experience in medical case management, health insurance, healthcare administration, or related fields; prior audit or quality assurance experience is highly beneficial.
• Comfort working independently in a remote setting, demonstrating reliability, professionalism, and confidentiality with sensitive information.
• Associate or bachelor’s degree in Healthcare Administration, Nursing (non-clinical roles), Public Health, or a related discipline preferred, or equivalent experience.
• Relevant certifications in case management, compliance, or quality assurance are a plus.