Current jobs related to Delegation Operations Nurse Auditor - East Long Beach - Blue Shield of California

  • Auditor

    11 hours ago

    Long Beach, United States Customs And Border Protection Full time

    In this position as an Auditor, you will work as an advanced trainee performing work assignments and completing training, serving as a support auditor on a team, and/or carrying out complete audits of lesser complexity independently or with the assistance of higher-level auditors. This position starts at a salary of $59,966.00 (GS-09, Step 1) to $77,955.00...

  • Senior Internal Auditor

    2 weeks ago

    Long Beach, United States CRC Full time

    Job Description - Senior Internal Auditor (00014152) Senior Internal Auditor California Resources Corporation is a publicly traded oil and natural gas exploration and production company and the largest oil and natural gas producer in California. We operate our world-class resource base exclusively within the State of California, applying complementary and...

  • Clinical Nurse Quality Auditor

    3 weeks ago

    Long Beach, California, United States Blue Shield Full time

    Position OverviewThe Clinical Access Program's Facility Site Review team is dedicated to ensuring that all MediCal members receive access to safe and high-quality healthcare providers. The Clinical Nurse Auditor, Consultant will report directly to the Clinical Training and Auditing Manager. In this capacity, you will evaluate physical site locations to...

  • Clinical Quality Auditor

    3 weeks ago

    Long Beach, California, United States Blue Shield Full time

    Position OverviewThe Clinical Access Program's Facility Site Review team is dedicated to ensuring that all MediCal members receive access to safe and high-quality healthcare providers. The Clinical Nurse Auditor, Consultant will report directly to the Clinical Training and Auditing Manager. In this capacity, you will evaluate physical site locations to...

  • Clinical Quality Auditor

    3 weeks ago

    Long Beach, California, United States Blue Shield Full time

    Position OverviewThe Clinical Access Program's Facility Site Review team is dedicated to ensuring that all MediCal members receive care from safe and high-quality providers. The Clinical Nurse Auditor, Consultant will report directly to the Clinical Training and Auditing Manager. In this capacity, you will evaluate physical site locations to confirm adequate...

  • Clinical Quality Auditor

    3 weeks ago

    Long Beach, California, United States Blue Shield Full time

    Position OverviewThe Clinical Access Program's Facility Site Review team is dedicated to ensuring that all MediCal members receive care from safe and high-quality providers. The Clinical Nurse Auditor, Consultant will report directly to the Clinical Training and Auditing Manager. In this capacity, you will assess physical site locations to confirm adequate...

  • Operations Auditor

    7 days ago

    Long Island City, United States FORTUNE SOCIETY INC Full time

    Job Title: Operations AuditorJoin the Fortune Society Inc. team as an Operations Auditor, where you will play a critical role in ensuring the organization's programs and services meet the highest standards of quality and compliance.About the RoleThe Operations Auditor will be responsible for leading internal agency-wide audits of programs, including chart...

  • Senior Internal Auditor

    2 weeks ago

    Long Beach, California, United States CRC Full time

    About the Role**Job Summary:**We are seeking a highly skilled Senior Internal Auditor to join our team at CRC. As a Senior Internal Auditor, you will play a critical role in ensuring the effectiveness of our internal controls and compliance with regulatory requirements.Key Responsibilities**Plan and Execute Compliance Efforts:**Develop and implement...

  • Internal Auditor, Principal

    3 weeks ago

    Long Beach, United States Blue Shield of CA Full time

    Your Role The Internal Audit Services team performs internal audits and advisory services to provide assurance on specific internal control objectives and emerging risk areas. The Internal Audit Principal will report to the Internal Audit Senior Director. In this role, you will be leading and managing financial, operational, and integrated audits and...

  • Quality Control Inspectors

    4 months ago

    Long Beach, United States Express Employment Professionals - Long Beach, CA Full time

    Job DescriptionJob DescriptionWe are seeking experience in Quality to join our team as Inspectors, Auditors or Process Specialist! You will conduct tests to determine the quality of materials and finished products as well as identify areas of improvement to increase efficiency.Responsibilities of Quality Control Inspectors / Quality Technical...

  • Clinical Nurse Auditor Consultant

    2 weeks ago

    Long Beach, California, United States Blue Shield of California Full time

    About the RoleWe are seeking a highly skilled Clinical Nurse Auditor Consultant to join our team at Blue Shield of California. As a key member of our Clinical Access Program's Facility Site Review team, you will play a critical role in ensuring that all MediCal members have access to safe, high-quality providers.Key ResponsibilitiesConduct thorough clinical...

  • Financial Operations Auditor

    3 weeks ago

    West Palm Beach, Florida, United States City of Riviera Beach Full time

    Position Overview The Municipal Audit Specialist will be responsible for executing financial, operational, and compliance assessments for the City. This role involves a variety of complex administrative tasks, including conducting thorough research, collecting and analyzing data, and assisting in the execution of substantive and compliance audit procedures....

  • Senior Internal Auditor

    2 months ago

    Long Beach, United States The Ladders Full time

    PRIMARY FUNCTION: This position is responsible for assisting the Board in performance oversight of the school programs and controls by conducting audits and analyses. REPORTS TO: Senior Director, Internal Audit SALARY SCHEDULE: A-5 WORK DAYS: 250 REQUIREMENTS: Education Level: Bachelor's degree in business administration, accounting, finance, or other...

  • Night Auditor

    2 weeks ago

    Myrtle Beach, South Carolina, United States La Quinta Myrtle Beach - 48th Avenue Full time

    Job SummaryWe are seeking a highly organized and detail-oriented Night Auditor to join our team at La Quinta Myrtle Beach - 48th Avenue. As a Night Auditor, you will be responsible for ensuring the accuracy of financial transactions and providing exceptional guest service.Key ResponsibilitiesFinancial Reconciliation: Reconcile all hotel cashier transactions,...

  • Night Auditor

    3 weeks ago

    Long Branch, United States Davidson Hospitality Full time

    Overview Are you a detail-oriented individual who thrives in a fast-paced environment? Join our team as a Night Auditor and play a crucial role in ensuring the smooth operation of our hotel during the night hours. We are seeking a dedicated and responsible individual who is passionate about providing exceptional guest experiences and is ready to take...

  • Premium Auditor

    3 weeks ago

    East Tawas, United States Davies Risk Services Full time

    Job DescriptionJob DescriptionGig Workers Wanted!  Are you tired of working for someone else?  Have you thought about building a business for yourself?  If you answered yes to either question – Welcome!  We are excited to introduce Davies Risk Services to you!  Our Premium Auditors come from various backgrounds.  If you are inquisitive, driven &...

  • Premium Auditor

    2 weeks ago

    East Tawas, United States Davies Risk Services Full time

    Gig Workers Wanted! Are you tired of working for someone else? Have you thought about building a business for yourself? If you answered yes to either question - Welcome! We are excited to introduce Davies Risk Services to you! Our Premium Auditors come from various backgrounds. If you are inquisitive, driven & self-directed, love numbers and spreadsheets,...

  • Night Auditor

    6 days ago

    Palm Beach, Florida, United States Marriott International Inc Full time

    Job SummaryWe are seeking a skilled Night Auditor to join our team at Marriott International Inc. As a Night Auditor, you will play a critical role in ensuring the smooth operation of our hotel's front desk and guest services.Key ResponsibilitiesProcess operational needs and address guest requests in a timely and professional manner.Complete reports and...

  • Night Auditor

    6 days ago

    Palm Beach, Florida, United States Marriott International Inc Full time

    Job SummaryWe are seeking a skilled Night Auditor to join our team at Marriott International Inc. As a Night Auditor, you will play a critical role in ensuring the smooth operation of our hotel's front desk and guest services.Key ResponsibilitiesProcess operational needs and address guest requests in a timely and professional manner.Complete reports and...

  • Auditor - Front Desk Operations

    2 weeks ago

    Clearwater Beach, Florida, United States Wyndham Grand Clearwater Beach Full time

    Job Summary:We are seeking a detail-oriented Night Auditor to join our team at Wyndham Grand Clearwater Beach. As a Night Auditor, you will play a crucial role in ensuring the smooth operation of our hotel during the night hours.Key Responsibilities:Perform front desk duties such as guest check-ins and check-outs during the night shiftProcess guest payments...

Delegation Operations Nurse Auditor

4 months ago

East Long Beach, United States Blue Shield of California Full time

Your Role

The Delegation Oversight Utilization Management team is responsible for the organization, tracking and data entry of IPA Utilization Management audits, issues, complaints and monitoring. Identifies root cause of the problem and maintains monthly reporting that track and compare patters of delegated entities. The Delegation Operations Nurse Auditor-LVN-Experienced will report to the Manager of UMDO. In this role you will be assist in maintaining continuous quality improvement in the Utilization Management Delegation Oversight Clinical Audit ensuring that departmental and organizational goals are accomplished through oversight and facilitating Utilization Management compliance of the Plan Partners.

Your Work

In this role, you will:

  • Be responsible for overseeing policy and procedure review and completing limited and less complex full desk or onsite Pre-delegation, Annual or follow-up audits /assessments of delegated entities, including vendors, in support of the regulatory and NCQA requirements.
  • Act as the auditor in charge on small and less complex audits, with supervision, of Sr. management and other delegated non-clinical areas through to corrective action plan oversight.
  • Research, investigate and oversee delegated entity’s compliance with reporting requirements by tracking the receipt and evaluating the completeness of reports.
  • Educate the delegated entities and vendors on area of expertise including but not limited to claims payment management, credentialing management, financial solvency, and system controls.
  • Collaborate on regulatory audits, findings responses or enforcements by regulatory agencies.
  • Responsible to write Corrective Action Plans and comprehensive summaries
  • Knowledge of DMHC, DHCS, CMS, Title 22 CCR, Title 28, Title 42, and Medi-Cal, Medicare processing guidelines
  • Ability to effectively communicate with internal and external associates
  • Responsible for reviewing criteria on denial letters
  • Responsible to handle multiple audits and able to prioritize workflow

Your Knowledge and Experience

  • Requires a bachelor's degree or equivalent experience
  • Requires an active California LVN license
  • Requires at least 3 years of prior relevant experience in auditing of claims, credentialing, or re-credentialing
  • Requires experience in auditing of utilization management or prior out-patient authorization review
  • Desired knowledge of accreditation entities and their requirements
  • Required ability to work independently
  • Required excellent verbal and written communication skill and interpersonal skills
  • Desired Computer ease & literacy with Word, Excel, Power Point Skills

Pay Range:

The pay range for this role is: $ 71280.00 to $ 99770.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

#LI-RU1