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Delegation Oversight Clinical Audit Manager
4 months ago
Title: Delegation Oversight Clinical Audit Manager, RN
Term: Direct-Hire, full time
Location: Fully Remote (Company located in Los Angeles, CA.)
Requirements:
- Bachelor's degree in nursing.
- Advanced Certification in Excel software program
- 6-8 years minimum of clinical auditing or healthcare focusing on Utilization Management
- 4-5 years minimum of supervisory/management experience.
Job Summary
The Manager, Delegation Oversight Clinical Audit is directly responsible for the oversight and monitoring functions for contracted providers, Participating Provider Groups (PPG), Plan Partners, and specialty health plans. The Delegation Oversight Clinical Audit Program activities include auditing delegated activities for compliance with State and Federal contractual compliance (CMS and DHCS) as well as accreditation standards (NCQA). The oversight activities include auditing delegated functions, performance monitoring for corrective actions, and reporting activities for internal committees as well as regulatory agencies. The position works closely with the Director, Delegation Oversight Audit on clinical issues/clinical review and interfacing with external agencies including other Local Initiatives, PPGs, and Health Plans. The position is further responsible to ensure all functions are operating in accordance with the organization's mission, values and strategic goals, are focused on continuous improvement; and are provided in a manner that is responsive and sensitive to the needs of L.A. Care's culturally diverse membership. This position manages all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports.
Company DescriptionThe company is a very successful and welll respected as one of the leading Health Care Organizations in the Country.Company DescriptionThe company is a very successful and welll respected as one of the leading Health Care Organizations in the Country.