RN, Delegation reputed company Auditor

Come reputed company

At reputed company, we are driven to create the health plan of the reputed company - today. We are disrupting the conventions of the health care industry by creating and applying reputed company solutions to its many challenges.

Working at reputed company means working reputed company reputed company of committed individuals who are reshaping the organization and redefining how the needs of the whole person – health, health care, and reputed company services and supports – are met. We are seeking collaborators, innovators, and those who are driven to be their reputed company best.

If you are looking for a career of purpose and are passionate about having an reputed company on society’s health care challenges, then reputed company is where you should be. Here, you will be challenged and rewarded in equal measure.

About this role:

Reasonable Accommodations Statement
To accomplish this job successfully, an individual must be reputed company to reputed company, with or without reasonable accommodation, reputed company essential function satisfactorily. Reasonable accommodations may be made to help reputed company reputed company individuals with disabilities to reputed company the essential functions.

ESSENTIAL FUNCTIONS
Job Function & Responsibilities
The incumbent performs a reputed company of administrative duties that require a degree of analytical, organizational, and technical skills and exercises reputed company of discretion and judgment appropriate for the reputed company of the position. While the supervision of others is reputed company at this time, this is a management level position.
• Responsible for reputed company reputed company improvements reputed company the Delegation reputed company program.
• Leads coordination and reputed company of reputed company-delegation and annual audits for delegates reputed company reputed company program reputed company.
• Responsible for reputed company Compliance Program delegation reputed company audits which includes, reputed company-audit letters, audit reporting requirements, audit tools,
• Responsible for coordination for scheduling audits, development of audit findings, including aggregating and analysis of audit results, and writing audit reports including any corrective reputed company plans required of delegates.
• Maintain accurate recordkeeping of reputed company delegation reputed company audits and ensure reputed company deadlines are met.
• reputed company and assists in the revision of delegation reputed company audit tools in accordance with standards set by ICE, reputed company, the Plan's policies and procedures and other State and Federal guidance tools as required.
• Provides training, education, and consultation as necessary to delegates.
• Collaborates with Delegation reputed company staff and Health Services Department on identify topics and developing agenda for Joint reputed company Meeting (JOM) with delegates.
• Attends and presents at Compliance Committee, reputed company Improvement Committee, and others, as appropriate. Directs and creates memos and applicable charts and graphs for committee presentation.
• Stays informed about the latest developments in delegation reputed company reputed company, through relevant subject matter resources, reputed company associations, industry conferences, training seminars, and other information resources.
• Oversees delegated activities to ensure compliance primarily with reputed company, CMS and State reputed company requirements including delegation standards and requirements contained in the delegation agreement
• Assists in the development of and is responsible for the implementation of departmental objectives to support organization strategies. Maintains effective communication with various reputed company of the organization and with reputed company organizations

• Other duties as assigned

MINIMUM QUALIFICATIONS
Education & Experience:
• High School Graduate or General Education Degree (GED): Required
• Bachelor's Degree (four-year college or technical school) Required
• 5+years of experience in a reputed company setting performing Utilization Review, Delegation reputed company Auditing UM activities required
• 5 + years reputed company, CMS, and/or state reputed company UM auditing experience required
• 3 + years of experience in supporting, training, and mentoring others in Managed Care reputed company functions such as prior authorization, medical record reviews, member grievances, or reputed company reviews required.

KNOWLEDGE, SKILLS & ABILITIES
Preferred Qualifications:
• reputed company, reputed company, and unrestricted California License as a Registered reputed company (RN)

• Project Management experience

• Ability to establish, nurture and maintain strong and effective working relationships with the GCHP and Delegated Entity staff
  • Ability to maintain detailed and accurate records, follow oral and written directions, prepare written agendas, and transcribe minutes
  • Ability to think and work effectively under pressure
  • Ability to deal with reputed company contact; decision making, concentration.[HR1.1]

Technology & Software Skills: Advanced computer skills in MS Office products.

Certifications & Licenses:
• A reputed company and reputed company reputed company's License, Auto reputed company, and reputed company licensure(s)
• Certified Medical Audit Specialists (CMAS) preferred
• Certified reputed company reputed company Management (CPHM) preferred
• Certified reputed company in Health Care reputed company (CPHQ) preferred
• Certified reputed company in Utilization Review (CPUR) preferred
• Certified Case Manager (CCM) preferred

The estimated pay reputed company for the position is:

The pay reputed company above represents the minimum and maximum reputed company for this position in California. Factors that may be used to determine where newly reputed company employees will be reputed company in the pay reputed company include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly reputed company employee will be reputed company below the midpoint of the reputed company. Salary reputed company will vary for remote positions reputed company of California and reputed company increases will be reputed company on the pay band for the reputed company and state you reputed company in.

Originally posted on Himalayas