Clinical Compliance Audit Manager

5 days ago


New York, New York, United States MetroPlusHealth Full time
Job Overview

MetroPlusHealth is a leading healthcare provider in New York, committed to delivering high-quality services to residents across the city. We are seeking an experienced Clinical Compliance Audit Manager to join our team.

About the Role

The Clinical Compliance Audit Manager will be responsible for leading monitoring and auditing activities of clinical business processes, ensuring compliance with regulatory requirements and internal policies. This role requires strong analytical and problem-resolution skills, as well as excellent written and verbal communication skills.

Key Responsibilities
  • Oversee day-to-day monitoring and auditing activities of clinical monitoring teams.
  • Perform internal clinical monitoring activities and audits, leading special projects as assigned by leadership.
  • Drive progress of corrective actions, providing oversight of corrective action plans issued to ensure timely implementation.
  • Communicate with compliance functional leaders to monitor vendor performance and address key outliers.
  • Compile reporting and develop analysis of compliance dashboards to present to department and division leadership.
Requirements
  • New York State license as Registered Nurse required.
  • Bachelor's degree required (BSN degree preferred); and at least 5-7 years of managed care clinical operations experience, with at least 3 years in a supervisory or managerial position.
  • Strong knowledge of utilization review requirements for Medicaid and Medicare products.
  • Experience with utilization review requirements for Medicare and Medicaid benefits.
  • Experience in delegated vendor oversight, corrective action plan implementation, and facilitating cross-functional work groups.
Competencies
  • Strong analytical and critical thinking skills.
  • Excellent written, oral, and presentation skills.
  • Advanced beginner or higher-level proficiency in Microsoft Suite products: Outlook, MS Teams, SharePoint, PowerPoint, Power BI, Power Automate, Visio, Word, and electronic medical record systems.
Salary Range

$95,000 - $115,000 per annum, depending on experience.



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