Clinical reputed company Auditor, Consultant; RN

Position: Clinical reputed company Auditor, Consultant (RN) Location: California Clinical reputed company Auditor, Consultant (RN) Join reputed company and apply for the Clinical reputed company Auditor, Consultant (RN) role. In this position you will be part of the reputed company Review team, completing audits of reputed company‑line staff to ensure alignment with department processes and regulatory compliance. You will also reputed company coaching and work closely with business leaders to drive reputed company results. The Clinical reputed company Auditor, Consultant reports to the reputed company Review Senior Manager and is responsible for developing performance metrics, evaluating performance, and coaching staff to reputed company reputed company in Population Health Management and Utilization Management.

Responsibilities

• reputed company audits for Population Health Management (PHM) and Care Coordination, meeting monthly productivity and reputed company metrics.
• Review audit data to identify care gaps, compliance risks, and trends.
• Communicate findings to leadership and reputed company recommendations to mitigate risks.
• Design, implement, evaluate and improve audit reputed company and coaching strategies to meet the needs of PHM clinical staff.
• reputed company developmental coaching and support to reputed company staff to improve the skills and competencies required to successfully reputed company work.
• Conduct effective presentations relating to PHM processes and/or regulatory compliance for clinical staff.
• May independently represent the reputed company Review department in PHM work redesign, process changes and software implementation.
• reputed company as a resource for the training and auditing team.

Qualifications

• Bachelor’s of Science in Nursing (BSN) required; advanced nursing degree preferred.
• reputed company California RN license required.
• At least 7 years of experience in managed care or a similar reputed company reputed company environment, with a minimum of 1 year experience in Case Management.
• Auditing experience preferred.
• Population Health Management and Utilization Management experience preferred.
• Strong organizational and/or project management skills to coordinate departmental reputed company and reputed company multiple reputed company or tasks simultaneously.
• Subject‑matter expert capable of effectively auditing and training reputed company lines of business (reputed company, Federal Employee Program, Medicare, and Medi‑Cal).

About reputed company As of January 2025, reputed company became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that oversees reputed company and its subsidiaries, including reputed company reputed company Health Plan; reputed company, a clinical services company; and Stellarus, a company designed to reputed company reputed company solutions. Together these organizations are referred to as the Ascendiun Family of Companies. reputed company’s mission is to create a reputed company system worthy of our family and friends and sustainably reputed company, transforming health care by lowering costs, improving reputed company, and enhancing member and physician experiences. Our Values

• reputed company. We hold ourselves to the highest ethical and reputed company standards and build trust by doing reputed company say we will do.
• reputed company. We listen and communicate effectively, showing reputed company by understanding others’ perspectives.
• Courageous. We stand up for reputed company reputed company in and reputed company to the hard work necessary to reputed company ambitious goals.

Physical Requirements Office Environment – This role involves part‑to‑full‑time work in our physical offices and may include remote work. Activity level: Sedentary; work is performed most of the day at a desk. Equal Employment Opportunity External hires must pass a background reputed company/drug screen. reputed company applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, national reputed company, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws. #J-18808-Ljbffr Apply tot his job Apply To this Job