*** JOB OPPORTUNITY *** GOLD COAST HEALTH PLAN invites applications for the position of: Delegation Oversight Auditor, RN OPENING DATE: 11/06/14 CLOSING DATE: Continuous DESCRIPTION: Under the general direction of the Compliance Officer/Director, leads, coordinates and participates in all delegation oversight audits of Gold Coast Health Plan’s vendors, service providers and delegated subcontracted providers according to regulatory and contractual requirements. In support of the Compliance Officer/Manager, assists in the liaison role between the subcontracted providers in the delegation oversight process. The position will also lead the delegation audit process, develop reports regarding audits, and analyze, track and trend audit findings. A second core function of the position is to support the Gold Coast Health Plan’s compliance department. The focus in this area is to convey information to and problem-solve issues for internal and external stakeholders. Provide guidance on regulatory requirements and reporting. Assist with regulatory audit(s) preparation and coordination. MAJOR FUNCTIONS AND ACCOUNTABILITIES: Class Characteristics: The incumbent performs a variety of administrative duties that require a degree of analytical, organizational and technical skills and exercises a level of discretion and judgment appropriate for the scope of the position. While the supervision of others is minimal at this time, this is a management level position. 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. Participates in the Compliance Committee meeting Assist in the Development & Implementation of the Delegation Oversight Program Assist the Compliance Officer/Director with complex tasks relative to Delegation Oversight & Compliance. EXPERIENCE, TRAINING, AND QUALIFICATIONS: RN required BSN preferred Minimum of 3-5 years of experience in an audit, compliance or delegation oversight role; preferably in a managed care environment. Demonstrated effective general writing skills and business report writing skills; ability to establish, nurture and maintain strong and effective working relationships with the GCHP and Delegated Entity staff; ability to maintain detailed and accurate records, follow oral and written directions, prepare written agendas and transcribe minutes; ability to use computers and software applications; demonstrated proficiency in the Microsoft Word, Excel, Access, and PowerPoint. Physical requirements needed to perform the essential functions of this job, with or without accommodation: ability to operate a keyboard and sit for long periods; ability to read close-up and do close-up work; ability to perform repetitive motion (keyboard); writing (note-taking); ability to hear normal speech, hear and talk on telephone; ability to think and work effectively under pressure; ability to deal with public contact; decision making, concentration. APPLICATIONS MAY BE FILED ONLINE AT: goldcoasthealthplan.org 2220 E Gonzales Road, Suite 200 Oxnard, CA 93036 805-981-5322 [email protected] Position #Com14DOARN DELEGATION OVERSIGHT AUDITOR, RN MV
Posted on: Tue, 25 Nov 2014 08:00:46 +0000
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