Clinical Nurse Auditor

2 weeks ago


Philadelphia, United States IntePros Consulting Full time

IntePros is seeking an experienced Clinical Nurse Auditor to work a hybrid work schedule in Philadelphia. Qualified candidate must have Managed Care, audit and oversight experience on utilization management, and case management and must have unrestricted RN license to practice either in NJ or PA.

• Performs audits and conducts ongoing monitoring of delegated entities to ensure compliance with federal and state laws, accreditation standards

• Reviews materials submitted, including policies, files, program documents and other materials relevant to the audit

• Conducts analysis of data related to vendor performance, and identifies opportunities for improvement

• Writes audit reports, manage corrective action plan

• Presents findings and recommendations to the Delegation Oversight Committee

• Conducts annual risk assessment that identifies and evaluates delegation risk

• Collects and prepare documents in preparation for audits.

• Actively participates in CMS program audits

• Knowledge of Part C Organization Determination guidelines and National Committee for Quality Assurance (NCQA) standards

#LI-DR2

#LI-Hybrid


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