Healthcare - Clinical Services Auditor
Company: APN Consulting
Location: Long Beach
Posted on: August 3, 2022
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Job Description:
Job DescriptionPosition: Clinical Services AuditorREMOTE/Hybrid
(Long Beach, CA)Duration: 3 MonthsJob Description:The position is
mostly remote, but there will be an onsite requirement for
candidates to report a few times a month to the Long Beach office.
Please ensure candidates are local to Long Beach, CA.Candidates
must have UM experience. Manager DOES NOT want to see resumes with
only case management or quality management experience.A strong
candidate will have experience processing referrals which differs
from candidates who have experience working at the hospital
receiving referral request.The referrals will be mostly for
Outpatient Professional Services.Potentially will be temp to hire
and may transition to an onsite role once Client's offices
reopenThis person will be conducting/monitoring audit activity to
review Utilization Management (UM) decisionsMust 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.Schedule: Monday to Friday, 8:30am to 5:3pm
PSTKnowledge/Skills/Abilities---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 Client 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.- Meets minimum production standards- May conduct staff
trainings as needed---Communicates with QA supervisor/manager about
issues identified and works collaboratively to resolve/correct
them.---15% travel required.Job QualificationsRequired
EducationBachelor's or Master's Degree in a social science,
psychology, gerontology, public health or social work.Required
ExperienceMinimum two years UM, CM, MAT, HM, DM, and/or managed
care experience.
Keywords: APN Consulting, Long Beach , Healthcare - Clinical Services Auditor, Other , Long Beach, California
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