Clinical Nurse Educator

The Clincal Auditor is responsible for performing monthly audits for the case management staff to oversee the quality of documentation, adherence to processes, etc. to ensure audit readiness. The Auditor/Trainer is expected to keep monthly reports of audit performance and findings and provide findings to specific employees and leadership in an effort to improve documentation requirements and audit compliance. The Auditor/Trainer will work with each employee to provide feedback and ensure improvement in audit results over time. The Auditor/Trainer will also complete audits as requested by health plans, HPN and others within the department. The Auditor/Trainer will be an integral part of training and onboarding of new employees. The Auditor/Trainer will provider recommendations of needed ongoing education to provide to the outpatient case management team. The Auditor/Trainer will assist in reviewing Job Aids, templates and other changes proposed within the department to ensure any changes will not negatively impact the department's audit standards and adherence to required guidelines. This position will work closely with the Case Managers, Coordinators, Managers, Directors, VPs and Medical Directors to ensure staff are performing to their full potential, as well as continual program development through training and process improvement.

Essential Duties and Responsibilities include the following:

1. Conducts clinically based concurrent and retrospective reviews of medical records to evaluate the clinical documentation for a reflective quality of care outcome and reimbursement compliance for services provided.
2. Conduct monthly reviews of each case manager's patients to ensure documentation is adhering to health plan requirements and department guidelines. In addition, will ensure that contact of members, completion of care plans, and presentation of patients to IDTs is meeting department and program requirements.
3. Maintain accurate records or each monthly review and each audit review.
4. Provide findings of reviews in a clear, concise and organized manner to management.
5. Provide findings of reviews in a clear, concise and organized manner to each case manager. Will work with case manager to educate and train to ensure improvement of any identified deficiencies.
6. Evaluates quality of clinical documentation practices and collaborates with clinical educator and management on remediation plan when indicated.
7. Identify, proactively through auditing and internal reporting, negative and positive trends and collaborates with management on recommendations for change.
8. Analyze data and conduct root cause analysis on data to determine best plan of correction.
9. Assist manager with follow-up on any problems or questions related to the audit results.
10. Interfaces with internal department staff telephonically, by e-mail or in person to obtain data.
11. Maintains a database for collecting the appropriate data and data-enters information thoroughly and accurately.
12. Produces charts, graphs, reports to demonstrate results and outcomes.
13. Assists with any corrective actions, as necessary.
14. Trains new employees on health plan and department requirements.
15. Works with management to create training schedule for case management team so that employees have continuing education.
16. Participates in audits conducted by HPN and health plans. This includes reviewing cases prior to meetings to identify potential deficiencies, prepare for audits so that all cases and the required information is easily accessible, participates in meetings as needed with HPN and health plans to go over our audit results.
17. Prepares and maintains records and files which are neat, organized, thorough and readily accessed.
18. Completes assignments within specified timelines.
19. Communicates with internal and external customers in a professional manner and follows through on commitments.
20. Written and verbal communication and transmission of information is clear, concise and is in proper business and grammatical format.
21. Adheres to Confidentiality and HIPAA regulations.
22. Filing, faxing, copying, purging of files.
23. Other duties as directed by management.

The pay range for this position at commencement of employment is expected to be between $83,200 and $104,000/[year]; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, employee will be in an "at-will position" and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

Full Time Position Benefits:

The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

Health and Wellness:

• Employer-paid comprehensive medical, pharmacy, and dental for employees
• Vision insurance
• Zero co-payments for employed physician office visits
• Flexible Spending Account (FSA)
• Employer-Paid Life Insurance
• Employee Assistance Program (EAP)
• Behavioral Health Services

Savings and Retirement:

• 401k Retirement Savings Plan
• Income Protection Insurance

Other Benefits:

• Vacation Time
• Company celebrations
• Employee Assistance Program
• Employee Referral Bonus
• Tuition Reimbursement
• License Renewal CEU Cost Reimbursement Program
• Business-casual working environment
• Sick days
• Paid holidays
• Mileage

Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

1. Graduate from an accredited school for Nursing (LVN or RN)
2. Current and maintains California Nursing License.
3. Minimum 3-5 years of clinical experience.
4. Required one (1) year of Case Management experience but 2-3 years of Case Management experience, preferred.
5. Three to five (3-5) years of managed healthcare experience required.
6. Computer literate in Word, Excel, and Powerpoint.

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