Compliance Auditor/Trainer (RN) Job at CareNational
Compliance Auditor/Trainer - Managed Care
Remote - TX, FL, IN, CO, GA, MO, KS, MT, AR
$27.00 - $32.00 / Hour is the amount that CareNational reasonably expects to pay someone for this position.
Job Summary:
Remote - TX, FL, IN, CO, GA, MO, KS, MT, AR
$27.00 - $32.00 / Hour is the amount that CareNational reasonably expects to pay someone for this position.
Job Summary:
- The Compliance Auditor/Trainer is responsible for auditing and monitoring trends and performing analyses for Medical Management teams including Precertification, Utilization Review, Case Management and Disease Management.
- Evaluate results of audits, call history and recordings to identify potential issues, reoccurring errors, and patterns that may require refresher training or development of training materials.
- Responsible for ensuring Third Party compliance with the company, Utilization Review Accreditation Commission (URAC), and state regulatory policies and procedures.
- Current, valid, and unrestricted state RN license. Must be a compact/multistate license and reside in one of the following states, TX, FL, IN, CO, GA, MO, KS, MT, AR.
- 2+ years of working within the healthcare industry, with a preference for any work experience relating to URAC, CMS, NCQA (HEDIS), and state regulatory environments.
- 2+ years of work experience in case management, care coordination, or utilization management.
- Prior experience working in a managed care environment (i.e. Health Plan, HMO, TPA, ACO, etc.)
- Knowledgeable in current healthcare regulations and the compliance process.
- Experience teaching adult learners. Must have a sound knowledge of adult learning theory and ability to present material to differing levels of base knowledge.
- Experience implementing processes for documenting, monitoring, auditing, and training program for provider compliance and program effectiveness.
- Computer skills to include Microsoft Word, Excel, database use, and basic data entry.
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