Description
General Summary of Position
The Nurse Auditor, Clinical Operations MFC DC and MD will coordinate all activities associated with clinical activities, including
the development and review of training, and auditing materials, performing auditing of clinical team members including but not
limited to Case Management (CM) and Utilization Management (UM), and preparation for the actual and mock NCQA audits. The
Nurse Auditor will perform audits to evaluate individuals' compliance with clinical processes, National Committee for Quality
Assurance (NCQA) standards, regulatory requirements, and of overall clinical program effectiveness and efficiency.
The Clinical Nurse Auditor will report to and work closely with the Assistant Vice President (AVP), Clinical Operations to monitor,
maintain, and support the clinical department to maintain a high level of quality performance and comply with regulatory
requirements and accreditation standards.
The Clinical Nurse Auditor participates on departmental and organizational project teams and plays a critical role in project
implementation by soliciting requirements through interviews, workshops, and/or existing systems documentation or procedures
and ensuring that all impacted processes and systems are evaluated.
The Clinical Nurse Auditor works closely with the Clinical Department in assisting with the definition, documentation, training, and
support for new required accreditation processes.
As a member of the Clinical Operations team the Clinical Nurse Auditor will have an opportunity to support improved accessibility
to key business information, ensure process integrity, and develop process flexibility which contributes to the success of the
organization.
The auditor will maintain current knowledge about NCQA, contract requirements, healthcare / industry trends, District regulations,
and other compliance standards.
*This position will cover both our MD and our DC teams and will require travel to both locations*
What We Offer
- Culture- Collaborative, inclusive, diverse, and supportive work environment.
- Career growth- Career mentoring to help you pursue your passions and gain skills to enhance your value.
- Wellbeing- Competitive salary and Total Rewards benefits to help keep you happy and healthy.
- Reputation- Regional & National recognition, advanced technology, and leading medical innovations.
Qualifications
- BSN from an accredited School of Nursing required.
- 1-2 years Case Management and utilization review experience required, and 1-2 years Auditing experience required, and 3-4 years Diverse clinical experience required.
- Valid RN license in the District of Columbia and Maryland required.
This position has a hiring range of $87,318 - $157,289
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