Nurse Auditors LVN/RN with CQM Experience
The CQM auditor performs Quality Monitoring to assure the regulatory compliance and quality of process in daily Utilization Management (UM) activities with minimal to moderate supervision. The auditor will work closely with the business units, Data Analysts and UM compliance to promote high quality, efficient and effective prior authorization process.
The auditor will be able to drive and present UM case files and complete interview with manger in any health plan or regulatory audit as well as work with business units for cap responses and remediation. This position requires knowledge of comprehensive regulation, UM policies & procedures, UM audit and quality improvement.
- Graduate from an accredited school for Nursing (LVN or RN).
- Current and maintains California Nursing License.
- Three to five (3-5) years of clinical experience preferred.
- Two to three (2-3) years of managed care experience preferred.
- Minimum one year (1) year of UM supervision/audit experience preferred.
- Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access, and Power Point).
- Typing 60 words per minutes with accuracy.
- Ability to deal with responsibility with confidential matters.
- Must have strong analytical, creative problem solving, and organizational skills.
- Ability to work in a multi-task, high stress environment.
- Ability to strategize effectively, execute within timelines, and deliver quality .
About the Hospital
As one of the largest physician-led networks in Southern California, we have thousands of physicians and hundreds of hospitals committed to providing quality healthcare to all of the communities we serve.
Every day, our employees are inspired to make a difference in the lives of others as well as transform their own experiences to achieve a higher sense of fulfillment. Our employees become a part of an extraordinary team of people dedicated to health, wellness, and happiness for themselves and others. There is no greater reward than contributing to a positive work environment where compassion, understanding, care and attention are encouraged and valued.