Clinical Services Auditor

Company: Judge Group
Location: Long Beach
Posted on: August 8, 2022

Job Description:

Apply Now Posted : March 18, 2022 Job Type : Contract Category : Healthcare Description Judge Healthcare is currently seeking a Clinical Services Auditor to join our client's growing team in the Long Beach, CA area This position is REMOTE but candidate must live in or near Long Beach.Schedule: Monday to Friday, 8:30am to 5:30pm PSTThis job will have the following responsibilities:Performs monthly auditing of registered nurse and other clinical functions in Utilization Management (UM), Case Management (CM), Member Assessment Team (MAT), Health Management (HM), and/or Disease Management (DM) and monitors key clinical staff for compliance with NCQA, CMS, State and Federal requirements. May also perform non-clinical system and process audits, as needed. Audits for clinical gaps in care from a medical and/or behavioral perspective to ensure member needs are being met. Assesses clinical staff regarding appropriate clinical decision-making. Reports monthly outcomes, identifies areas of re-training for staff, and communicates findings leadership. Ensures auditing approaches follow a Molina standard in approach and tool use. Maintains member/provider confidentiality in compliance with the Health Insurance Portability and Accountability Act (HIPAA) and professionalism with all communications. Adheres to departmental standards, policies, protocols. Maintains detailed records of auditing results. Assists HCS training team with developing training materials or job aids as needed to address findings in audit results. 15% travel required.Qualifications & Requirements:Bachelor's or Master's Degree in a social science, psychology, gerontology, public health or social work.Must have an LVN or RN (CA State license) Must have at least two years of experience in Utilization Management (UM)One year of auditing/ clinical review experience preferredTwo years CM, MAT, HM, DM, and/or managed care experience preferred.If you or someone you know is interested in this position, please send a current resume to Kelly at or 214-281-5947 Apply now

Keywords: Judge Group, Long Beach , Clinical Services Auditor, Healthcare , Long Beach, California