Hospital audit nurse auditor
Working Nurse
Job Description
The Delegation Oversight Clinical Auditor RN II is responsible for ensuring that delegates contracted to perform Utilization Management (UM) functions on behalf of L.A. Care (LAC) comply with all UM regulatory requirements and new legislation. This is achieved through the maintenance of required policies, procedures, workflows, processes, and audit tools necessary to meet those requirements.
This role utilizes a rapid team approach to implement improvements identified through external audits of delegated entities. It assists in maintaining continuous quality improvement in the Delegation Oversight Clinical Audit unit, ensuring that departmental, divisional, and organizational goals are met by overseeing and facilitating compliance of the Plan Partners, Participating Provider Groups (PPG), Specialty Health Plans (SHP), and contracted provider networks managed by the Delegation Oversight Department.
The auditor participates in the oversight team, ensuring compliance of the Plan Partners and/or Participating Physician Groups (PPG) with regulatory, contractual, and L.A. Care requirements. Responsibilities include performing annual and focused audits, acting as a liaison between the Plan Partners, PPGs, and L.A. Care Health Plan regarding UM issues, and providing continuous feedback to improve access and utilization performance of Plan Partners and PPGs.
Qualifications
Associate's Degree in Nursing
Bachelor's Degree in Nursing (preferred)
At least 7 years in a clinical setting with at least 3 years in a managed care setting in Utilization Management/Case Management
About The Hospital
As the nation's largest publicly-operated health plan, we have a great responsibility to the communities we serve, and our employees play an essential role in ensuring we meet those needs.
Why Join Us
Opportunity, amazing co‑workers, a supportive management team, great compensation and benefits, camaraderie, and a true sense of mission. Join us as we work towards a healthier L.A.
#J-18808-Ljbffr Working Nurse
$88.85k
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