RN Job

Clinical Assurance Compliance Nurse Specialist RN II

Full Time
Pay Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.)
Job ID: 10265
Los Angeles, 90017

The Clinical Assurance Compliance Nurse Specialist RN II is responsible for the review of regulatory, contractual and accreditation standards to ensure Health Care Services Department policies are in compliance and in operation. The position works closely with Regulatory Affairs and Compliance to ensure timely exchange of documentation to evidence compliance.

The position is responsible for the internal auditing process for referral management and complex case management using approved auditing/monitoring tools. This position participates in the review and presentation when necessary of training materials for external delegates and internal staff training. 

Qualifications

Education Required

  • Associate's Degree in Nursing

Education Preferred

  • Bachelor's Degree in Nursing

Experience Required:

  • At least 5-7 years experience in a clinical setting and in a managed care plan performing UM oversight, including auditing.
  • Good working knowledge of licensure and regulatory requirements, and accreditation standards;
  • Managed Health Care experience.
  • Knowledge of issues pertaining to Medi-Cal, Medicare, and other HMO & IPA contracts & payers.
About the Hospital

As the nation's largest publicly-operated health plan, we have a great responsibility to the communities we serve, and our employees play an essential role in ensuring we meet those needs.

Why Join Us?
Opportunity. Amazing co-workers. A supportive management team. Great compensation and benefits. Camaraderie and a true sense of mission. If you want a career that truly contributes to the good of all, join us as we work towards a healthier L.A.

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