Rn Auditor

Salary Range: $61,176 - $88,705

Job Summary

Under the direction and supervision of the Audit Manager, and through collaboration with Directors and Management level staff, this position conducts audit activities of varying complexity and supports initiatives of moderate to complex difficulty related to CenCal Health's audits, monitoring, and oversight program. This includes the performance of routine and complex audit, monitoring, and oversight activities of internal departments and external partners to ensure compliance with Medi-Cal and Medicare regulatory and contractual requirements, and operational plan requirements,as well as assisting in writing, reviewing, and coordinating corrective action plans.

Duties & Responsibilities

• Conducts routine and complex compliance audit activities, documenting results in audit work papers, developing detailed document request lists, conducting audit conferences and walk-throughs, and proposing recommendations for improvement.
• Conducts audits of the Plan's delegates to ensure compliance with regulatory, contractual requirements, and HIPAA Privacy Standards.
• Assists in developing risk assessments.
• Assists in the maintenance of CenCal Health's risk logs and audit tools.
• Assists and supports the development, implementation, and maintenance of the Compliance Audit Program to ensure key performance indicators are met and compliance risks are proactively identified.
• Conducts routine monitoring activities to ensure compliance with regulatory and contractual requirements.
• Develop and maintain audit tools based on regulatory compliance with DHCS, DMHC, NCQA and CMS requirements.
• Ability to write clear and concise audit reports based on audit results, ensuring accuracy and quality of audit reporting.
• Validates effective implementation of corrective action plans (CAPs) from internal departments and delegated entities to ensure appropriate completion and to make necessary recommendations as needed for compliance.
• Creates reports and analyzes data for reporting to management, the Delegation Oversight Committee, Compliance Committee, and Board of Directors.
• Conducts regulatory research and provides an interpretation of regulations to ensure appropriate application.
• Prepares and sends out audit announcement memos.
• Prepare audit programs and conduct audits of assigned areas, including performing various audit procedures and documenting audit findings.
• Perform and coordinate follow-up audits to determine if management has taken action to mitigate the risks identified.
• Provide independent evaluations and assist with the maintenance of operational controls, tools, policies, and procedures.
• Assists and supports the development of materials for audit Entrance and Exit conferences.
• Other duties as assigned.

Knowledge/Skills/Abilities

Required:

• Audit experience with understanding of audit standards and requirements.
• Experience with Medi-Cal, CMS, and Knox-Keene regulatory requirements, NCQA standards, managed health care, health care industry terminology.
• LVN license desirable. Active/unrestricted RN license preferred
• Excellent written and verbal communication skills with strong business writing aptitude;
• Experience researching, compiling, and organizing information from various sources.
• Strong organizational skills and attention to detail;
• Strong skills in problem identification, analysis, resolution, organization, and prioritization;
• Ability to reprioritize workload as needed;
• Ability to work productively with all Plan staff;
• Ability to coordinate work between departments;
• Ability to work with minimal supervision, both independently and in teams;
• Attention to detail and accuracy is a must for this position

Desired:

• Regulatory Auditing experience with DHCS, CMS, DMHC, and/or NCQA.
• Experience in health care compliance preferred.

Education & Experience

• Two-three (2-3) years' experience in the health care field with auditing, quality assurance/quality improvement experience, compliance, or other highly regulated industry.
• Associate Degree in Nursing or Bachelor of Science in Nursing from an accredited institution highly desirable.
• Certified Internal Auditor (CIA), Certified Health Care Compliance (CHC), Certified Healthcare Auditor (CHA), CHIAP (Certified Healthcare Internal Audit Professional) preferred or ability to achieve certification within 1 year.