Quality Assurance Clinical Auditor - RN

Village Care•New York, NY

9d•$110,000 - $115,000•Hybrid

About The Position

Are you ready to elevate your nursing career? Join VillageCare as a Full-Time Quality Assurance Clinical Auditor - RN, where you'll have the excitement of impacting healthcare quality with flexibility to work from home. This hybrid position places you at the forefront of enhancing patient care through meticulous auditing practices. With a competitive salary range of $110,000-$115,000, this role allows you to both thrive professionally in a high-performance environment and enjoy a work-life balance that suits your lifestyle. Your expertise will help us maintain our commitment to excellence and customer-centric care. As a team member you'll be able to enjoy benefits such as a generous PTO package, 10 Paid Holidays, Personal and Sick time, Medical/Dental/Vision, HRA/FSA, Education Reimbursement, Retirement Savings 403(b) with a yearly 5% employer contribution, Life & Disability, Commuter Benefits, Paid Family Leave, and Additional Employee Discounts. Don't miss the chance to be part of a forward-thinking team dedicated to integrity and quality in healthcare! Apply today! VillageCare: Our Story VillageCare is a community-based, not-for-profit organization serving people with chronic care needs, as well as seniors and individuals in need of continuing care and managed care services. Our mission is to promote healing, better health and well-being to the fullest extent possible. Our care is offered through a comprehensive array of community and residential programs, as well as managed care. VillageCare has delivered quality health care services to individuals residing within New York City for over 45 years. Your day as a Quality Assurance Clinical Auditor - RN As a Quality Assurance Clinical Auditor at VillageCare, you will play a pivotal role in ensuring that all Clinical and Medical Management activities adhere to federal and New York State regulatory requirements, including CMS and NYSDOH mandates. Your responsibilities encompass identifying risks, developing processes, and conducting audits in collaboration with business owners to maintain compliance with healthcare standards. You'll actively support the development and revision of policies and procedures, while also providing crucial training and support to both clinical and non-clinical staff. By monitoring regulatory changes and industry trends, you'll educate your colleagues and facilitate initiatives that promote a culture of excellence and integrity. With a focus on continuous improvement, you will contribute to corrective action plans and compliance tracking, ensuring that the organization remains audit-ready.

Requirements

Current NYS Registered Nurse License
Bachelor of Science in Nursing (BSN)
3-5 years of experience in Utilization Management or Managed Care, with specific knowledge of quality monitoring and compliance for Medicare lines of business.
Proficiency in quality measurement systems is required
At least two years of experience in workforce development and resource management.
Strong leadership, collaboration, and motivational skills
Ability to multitask and thrive in a fast-paced environment
Excellent written and verbal communication skills
Expertise in data analysis

Responsibilities

Ensuring that all Clinical and Medical Management activities adhere to federal and New York State regulatory requirements, including CMS and NYSDOH mandates.
Identifying risks, developing processes, and conducting audits in collaboration with business owners to maintain compliance with healthcare standards.
Actively support the development and revision of policies and procedures
Providing crucial training and support to both clinical and non-clinical staff.
Monitoring regulatory changes and industry trends
Educating colleagues and facilitate initiatives that promote a culture of excellence and integrity.
Contributing to corrective action plans and compliance tracking, ensuring that the organization remains audit-ready.