RN Auditor

Earning the right to be good at it – comes from a very deep desire to make that perfect match. It comes from wanting to help individuals optimize their career possibilities – it comes from having experienced the issues involved with hiring – specially hiring the right candidate – and trying to make a process that traditionally has been a hit or miss type process into a science, minimizing the art, and stacking the odds in favor of matching the absolute right candidate with the right assignment.

We have taken our passion for matchmaking, our talents of leveraging & analyzing data, our predictive algorithms based on proprietary behavioral, psychological and personality testing, combined with an extensive investigation for each candidate considered and using state of the art neural modeling technology, have successfully taken what used to be more of an art and a hope process to a very scientific – quantifiable process – almost like matching DNA.

We get immense pride from delivering a product that others cannot and have not – we have a very unique approach to this business – we have chosen to specialize in some very narrow niches – but in those very narrow niches – we can do better than any other. We have:

Built the most extensive database of candidates domain specific.

Major Duties and Responsibilities:

Lead/Coordinate the scheduling of delegation oversight audits.

Provide administrative support to Health Plan staff in the acquisition and distribution of files for audit.

Participate in the audit process. Assist Health Plan staff in the development and routing of the audit findings. Aggregate and analyze audit findings into a reportable format for management use.

Maintain accurate recordkeeping of all delegation oversight audits and ensure all deadlines are met.

Assist in the revision of delegation oversight audit tools in accordance with standards set by

ICE, NCQA, the Plan's policies and procedures and other State and Federal guidance tools as required.

Participates in Joint Operations Committee (JOC) meetings.

SKILLS & ABILITIES
Business, Health Sciences, Managed Care

Registered Nurse (RN).Required

Experience:
3 plus years of experience in an audit, compliance or delegation oversight role; preferably in a managed care environment

Study: BSN

All your information will be kept confidential according to EEO guidelines.