Case Auditor

Accountabilities: Conduct regular audits of care management records, documentation, and workflows to assess compliance with internal policies, NCQA standards, and applicable regulatory requirements. Review cases for accuracy, consistency, completeness, and adherence to healthcare quality and compliance standards. Identify trends, discrepancies, documentation gaps, and potential risks, providing clear and actionable recommendations to leadership. Develop and maintain audit tools, scorecards, tracking systems, and review methodologies that support consistent and objective evaluations. Collaborate with care management leadership to address audit findings and develop or implement corrective action plans. Support the development and updating of care management policies, procedures, and training materials based on audit results. Monitor process changes and corrective actions to assess whether improvements are sustained and compliance objectives are achieved. Provide guidance and feedback to care management leadership regarding documentation requirements, best practices, and quality standards. Participate in training and staff education initiatives focused on compliance, documentation, and care management excellence. Prepare audit reports and communicate findings, trends, performance metrics, and recommendations to management. Track compliance trends and improvement initiatives to evaluate program effectiveness and support data-informed decision-making. Work collaboratively with internal leadership and participate in internal or external audits when required. Follow organizational policies, standards, and procedures and perform other related duties as assigned. Requirements High school diploma or GED required. 2–4 years of relevant professional experience required. Vocational or technical education and additional on-the-job or continuing education may be applicable. Experience with healthcare auditing, case management, quality assurance, or regulatory compliance is preferred. Familiarity with NCQA, HEDIS, CMS, state healthcare guidelines, and related regulatory or accreditation requirements is highly desirable. Strong computer skills and the ability to work effectively with audit tools, documentation systems, tracking platforms, and data. Excellent written and verbal communication skills, with the ability to present findings and recommendations clearly. Strong customer-service, organizational, analytical, and time-management skills. High attention to detail and the ability to identify inconsistencies, assess risk, and translate findings into practical improvements. Ability to manage multiple priorities, meet deadlines, work independently in a remote environment, and collaborate effectively with leadership and care management teams. Oklahoma residency is required for this fully remote position. Availability to work Monday through Friday, 8:00 AM to 5:00 PM. Benefits Hourly pay range of $20.39–$34.71 , with actual compensation adjusted based on skills, experience, education, and other applicable job-related factors. Comprehensive health insurance options. 401(k) and stock purchase plans. Tuition reimbursement. Paid time off and paid holidays. Flexible work approach with remote, hybrid, field, or office arrangements where applicable. Potential additional incentive compensation, subject to applicable eligibility requirements. Opportunity to contribute to healthcare quality, compliance, and improved outcomes for members and communities. Support for workplace accommodations for qualified applicants.