Delegation Oversight Auditor I
Gold Coast Health Plan
Delegation Oversight Auditor I
Gold Coast Health Plan
full-time
Posted on:
Origin: • 🇺🇸 United States • California
Visit company websiteSalary
💰 $73,500 - $110,250 per year
Job Level
Mid-LevelSenior
About the role
- Leads, coordinates, participates in delegation oversight and internal audits of vendors, service providers, delegated providers and internal departments Serves as liaison between subcontracted providers and leadership Assists with clinical oversight audit process, develops reports, analyzes and trends audit findings Supports compliance department and regulatory audit preparation Coordinates scheduling, audit findings development, writing audit reports and corrective action plans Maintains audit recordkeeping and deadlines Oversees revision of delegation oversight audit tools per ICE, NCQA, State/Federal guidance Provides training, education, consultation to delegates Collaborates on Joint Operations Meeting agenda development Presents at Compliance and Quality committees and creates memos, charts, graphs Assists in development and implementation of quality improvement, remediation, corrective action plans Supports audit projects with clinical components Other duties as assigned
Requirements
- High School Graduate or GED required Bachelor's Degree (BSN, Business, Health Sciences, Managed Care) required or 4 years equivalent experience 5+ years clinical setting experience performing Audit, Utilization Review, Delegation Oversight Auditing and UM activities 1-2+ years audit experience preferred 5+ years NCQA, CMS, and/or state Medicaid UM auditing experience 3+ years supporting, training, mentoring in Managed Care clinical functions Project Management experience preferred Advanced proficiency in Microsoft Word, Excel, Access, PowerPoint Preferred certifications: CMAS, CPHM, CPHQ, CPUR, CCM, RN Ability to establish relationships, maintain records, follow directions, work under pressure, public contact, decision making, concentration
