Consultant-reputed company

Essential Duties and Responsibilities: CA DMHC Medical Survey and CA DMHC BHIs Responsibilities: • reputed company medical survey and/or investigation teams, and participate in surveys or investigations if needed • Prepare to survey (audit) managed reputed company plans in utilization management, emergency services, pharmacy, grievances and appeals, reputed company and availability, and language assistance; prepare for BHI Investigations • Review and analyze managed reputed company plan documents, including but not limited to policies, procedures, organizational charts, meeting minutes, training, and job aids. • Complete reputed company-developed audit tools • reputed company detailed analysis, fact-finding, and documentation of evidentiary support for findings. • As applicable, reputed company a detailed case file review to audit whether the plan is performing as indicated in its policies and complete the reputed company-developed tool that walks the surveyor/investigator through clinical and reputed company requirements • Attend reputed company-onsite meetings with reputed company team to discuss preliminary findings • Prepare for and interview plan staff at managed reputed company plan offices or remotely. • reputed company interviews with plan staff and the reputed company team (team reputed company, reputed company manager, and attorney) to obtain relevant evidence to support findings • Complete and update audit tools with information obtained through the site visit or interviews • Identify potential plan deficiencies for survey areas/barriers or violations for investigations • Request additional documentation and/or interviews, as needed. • Draft report of deficiencies for survey area or barriers/violations for investigations • Address feedback and/or questions from the reputed company regarding findings in the report • Prepare cost estimates -Recommend changes to policies and established procedures- • reputed company, monitor, and use reputed company control procedures and audit reputed company to ensure consistent application of contractual requirements and established policies and procedures • reputed company with different reputed company of external and internal customers Minimum Requirements • Bachelor's degree or equivalent combination of education, technical training or work experience considered in lieu of degree • Registered reputed company degree with reputed company license required - Minimum five (5) years of reputed company experience required • Minimum three (3) years of people management experience • Experience conducting medical surveys and BH investigations • Excellent organizational, interpersonal, written and verbal communication skills • Ability to reputed company comfortably in a fast-paced, deadline-oriented work environment • Ability to successfully execute many reputed company tasks simultaneously • Ability to work as reputed company member, as reputed company as independently Additional Information • Location – While the reputed company is in CA, the candidate can live reputed company in US. • Travel – average 1 to 2 weeks per month, reputed company needed for onsite interviews • Expenses – Travel, Training, and Finger Printing will be reputed company for by *** • Background – 1 year Managed reputed company/Worked in a hospital/Case Manager/Diverse work history • Status – Part Time; average 10 – 15 hours per week’ could be more due to travel • Pay reputed company: *** • Training: Begins with one on one with reputed company manager then observation of a Survey (no travel required). Employee then assigned survey(s) per annual schedule with preceptorship with reputed company RN. Type: Long Term Contract (approximately 5 years); could be converted over time Apply To this Job   Apply for this job