RN Job

Delegation Oversight Clinical Auditor RN II

Full Time Regular
Req #8569
Los Angeles, 90017

The Facility Site Review Nurse Specialist RN II conducts face-to-face visits with our high-membership physicians to provide feedback, data, and education on programs and facilitates changes to improve quality of care and service to members. Conducts various types of site reviews of PCP and specialist sites to ensure quality FSR and physician compliance with Local, State, and Federal requirements.  

Conducts Full Scope Reviews, Site Review Surveys, Medical Record Review Surveys, Specialty Site Review Surveys, PARS assessments, Focused Reviews, Interim Onsite Reviews, Consultation/Educational Site visits, Investigative visits, HEDIS related visits, and/or other appropriate site visits.

Qualifications
  • Education Required Associate's Degree in Nursing
  • Education Preferred Bachelor's Degree in Nursing
  • At least 5-7 year clinical experience including, but not limited to ER/Acute care nursing or outpatient setting.
  • Preferred: Medi-Cal managed care auditing experience.
  • At least  one (1) year experience in Quality Improvement and  DHCS audit tool.
  • Excellent verbal and written communication skills. 
  • Excellent organizational and time-management skills. 
  • Proficient in Microsoft Office.
  • Current and unrestricted California RN License, Nurse Practictioner License or Physician Assistant License
  • Department of Health Care Services (DHCS)
  • Certified Site Reviewer and/or Department of Health Care Services (DHCS)
  • Certified TrainerLicenses/Certifications Preferred
  • Certified Professional in Healthcare Quality (CPHQ)
  • Department of Health Care Services (DHCS)
  • Certified Site Reviewer and/or Department of Health Care Services (DHCS)
  • Certified Trainer
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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