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Clinical Quality Auditor

Quality and Risk Adjustment | Virtual - Any US CINQCARE Location | Full Time | From $85,000 to $95,000 per year

Job Description

About CINQCARE

CINQCARE is a provider-led, community-based health and care partner dedicated to improving the health and well-being of those who need care the most, with a deep commitment to high-needs, urban and rural communities. Our local physicians, nurses, and caregivers work together to serve people and the communities they live in, beyond just treating symptoms. We remove barriers by delivering personalized care as close to home as possible, often in-home, because we know a deep understanding of our patient’s race, culture, and environment is critical to delivering improved health outcomes. By empowering patients, providers, and caregivers with the support they need, we strive to make health and care a reality—not a burden—every single day. Join us in creating a better way to care.

Overview

The Clinical Quality Auditor reports to the VP, Head of Compliance and Risk Management with accountability for providing strategy, judgment, organization, and evidence-based analysis to influence decisions, and directly to meet CINQCARE requirements. They should embody CINQCARE’s core values, including, Trusted, Empathetic, Committed, Humble, Creative and Community-Minded. At CINQCARE, we don’t have patients or customers – we have Family Members.

Primary Responsibilities

  • Conduct regular audits of patient records, clinical procedures, and treatment plans to ensure compliance with internal policies, regulatory standards, and best practice guidelines.
  • Review clinical documentation for accuracy, completeness, and consistency, identifying any discrepancies or non-compliance issues.
  • Evaluate patient care processes to identify areas of improvement and ensure adherence to clinical protocols, evidence-based practices, and regulatory requirements.
  • Provide comprehensive feedback to clinical teams and leadership on audit results, offering constructive recommendations for improving quality and compliance.
  • Maintain accurate and up-to-date records of audits, corrective actions, and follow-up outcomes to track progress and ensure sustained compliance.
  • Develop and update clinical audit tools to meet the needs of the various lines of business.
  • Travel to multiple states for meetings and audits will be required.

The Clinical Quality Auditor should have the following duties:

  • Leadership: The Clinical Quality Auditor will lead in defining and executing strategies and solutions to create business value in auditing, including building a team to design, develop, and execute those strategies and solutions to deliver desired outcomes.
  • Strategy: The Clinical Quality Auditor will establish the business strategy and roadmap: (1) improve outcomes for CINQ Care Inc. members, and (2) enhance the efficacy of other CINQ Care Inc. business divisions.
  • Collaboration: The Clinical Quality Auditor will ensure that audit capabilities form a cohesive offering, including by working closely with other business divisions to learn their needs, internalize their knowledge, and define solutions to achieve the business objectives of CINQCARE Inc.
  • Knowledge: The Clinical Quality Auditor will provide subject matter expertise in the auditing solutions, including determining and recommended approaches for audits, solution deployment and performance evaluation.
  • Culture: The Clinical Quality Auditor is accountable for creating a productive, collaborative, safe and inclusive work environment for the auditing team and as part of the larger Company.

Qualifications

The Clinical Quality Auditor should have the following qualifications:

  • Education. Bachelor’s or equivalent degree with a record of strong academic achievement. RN preferred, or LPN with 5 years of clinical experience. ***Must have a current, unencumbered license***
  • Experience. At least 5 years of auditing experience. Ideal candidates will have 5+ years of relevant auditing experience in the healthcare industry.
  • Communication. Excellent verbal, written communication and presentation skills; ability to clearly articulate and present concepts and models in an accessible manner to CINQ’s team, investors, partners and other stakeholders. Proficiency in all Microsoft Office applications.
  • Relationships. Ability to build and effectively manage relationships with business leaders and external constituents.
  • Culture. Good judgement, impeccable ethics, and a strong team player; desire to succeed and grow in a fast-paced, demanding and entrepreneurial Company.

Our Benefits

At CINQCARE, we care for our team like we care for our patients—holistically. We offer flexible, comprehensive benefits so you can thrive while delivering top-notch care.

  • Medical Plans: Two comprehensive options offered to Team members.
  • 401K: 4% employer match for your future.
  • Dental & Vision: Flexible plans with in-network savings.
  • Paid Time Off: Generous PTO, holidays, and wellness time.
  • Extras: Pet insurance, commuter benefits, mileage reimbursement, CME for providers, and company-provided phones for field staff.

The working environment and physical requirements of the job include:

Work is performed indoors in a setting with conditioned air and artificial light. Travel to and work in offices or other environments is required. In this position you will need to communicate with customers, vendors, management, and other co-workers in person and over devices, sometimes with people who are agitated. Regular use of the telephone and e-mail for communication is essential. Sitting for extended periods is common. Must be able to receive ordinary information and to prepare or inspect documents. Lifting of up to 10 lbs. occasionally may be required. Good manual dexterity for the use of common office equipment such as computer terminals, calculator, copiers, and FAX machines. Good reasoning ability is important. Able to understand and utilize management reports, memos, and other documents to conduct business, including the development of spreadsheets and presentation materials.