Auditor, Case Manager RN

Regal Medical Group•Los Angeles, CA

11d•Onsite

About The Position

The Case Management Auditor is responsible for performing monthly audits for the case management staff to oversee the quality of documentation, adherence to processes, etc. to ensure audit readiness. This position will work closely with the Clinical Educators and Managers to ensure staff are performing to their full potential, as well as continual program development through training and process improvement.

Requirements

Graduate from an accredited school for Nursing (LVN or RN)
Current and maintains California Nursing License.
Knowledge of admission and continued stay criteria for levels of care in acute care setting.
Minimum 3-5 years of clinical experience.
Minimum one (1) year of Quality Management experience.
Computer literate in Word, Excel.

Nice To Haves

Three to five (3-5) years of managed healthcare experience preferred.

Responsibilities

Conducts clinically based concurrent and retrospective reviews of medical records to evaluate the clinical documentation for a reflective quality of care outcome and reimbursement compliance for services provided.
Evaluates quality of clinical documentation practices and collaborates with clinical educator and management on remediation plan when indicated.
Identify, proactively through auditing and internal reporting, negative and positive trends and collaborates with clinical educator and management on recommendations for change.
Analyze data and conduct root cause analysis on data to determine best plan of correction.
Assist manager with follow-up on any problems or questions related to the audit results.
Interfaces with internal department staff telephonically, by e-mail or in person to obtain data.
Maintains a database for collecting the appropriate data and data-enters information thoroughly and accurately.
Produces charts, graphs, reports to demonstrate results and outcomes.
Assists with any corrective actions, as necessary.
Prepares and maintains records and files which are neat, organized, thorough and readily accessed.
Completes assignments within specified timelines.
Communicates with internal and external customers in a professional manner and follows through on commitments.
Written and verbal communication and transmission of information is clear, concise and is in proper business and grammatical format.
Adheres to Confidentiality and HIPAA regulations.
Filing, faxing, copying, purging of files.
All other duties as directed by management.