Sr. Clinical Quality Auditor & Trainer

Integrated Home•Miramar, FL

About The Position

Who we are: IHCS provides an Integrated Delivery System in the home setting, which includes, DME, Respiratory, Home Health and Home Infusion services. IHCS has a select network of Medicare and/or Medicaid Certified and Accredited providers to respond to the needs of our patients – 24/7. We operate with the sole intent of providing the highest quality in-home care services that improve and enhance the daily living for our patients, where our patients are #1 Our delivery model is trusted by national Managed Care Organizations (MCOs), physicians and patients, positioned with over two decades of expertise as the market leader in value-based Home Health, Durable Medical Equipment, and Home Infusion Services. We currently serve over 2 million lives throughout the nation and the Commonwealth of Puerto Rico. Join our team as we strive for excellence through teamwork delivering high quality care to our patients through Exceptional Customer Service, Proven Outcomes, and Seamless Care. Offering a competitive compensation package, including but not limited to; Medical, Vision, Dental, Short- and Long-term insurance 6+ Days of Holidays Pay 15+ days of PTO Employer paid life insurance 401K with employer contribution Wellness program with reward incentives Employee recognition and reward programs What you will be doing: Support compliance and quality initiatives by identifying and developing the ongoing needs of the department. Provide input toward solution to department audits. Develop and (Run/establish/monitor/ make recommendations of audits) Ensure compliance and adherence to Federal and State regulations and contractual requirements as well as direct contribution to the prevention detection and elimination of fraud waste and abuse in the organization and in network. Remain current on Health plan regulations and make certain rest of compliance group is aware of changes. Escalates critical issues or potential concerns to Compliance Officer/DME Director and may be asked to represent in business meetings or similar settings. Lead and execute end-to-end internal quality audits, risk assessments, and root cause analyses across clinical, operational, and administrative areas. Develop audit plans, tools, and protocols in accordance with CMS, NCQA, URAC, HIPAA, and other regulatory or accreditation standards. Monitor corrective action plans (CAPs) and track implementation through closure, providing coaching to departments when needed. Prepare audit summary reports, dashboards, and executive-level presentations on audit findings and trends. Serve as lead liaison during external audits, surveys, or mock audits, representing the organization with regulators, payers, and accreditation bodies. Maintain and revise standard operating procedures (SOPs) and work instructions related to QA activities. Collaborate with Quality Improvement, Compliance, Operations, and Medical Management teams to implement best practices. Assist with training and mentoring of QA staff and audit interns. Identify and recommend process improvements and automation opportunities. Participate in quality committees and enterprise-level initiatives. Ensure audit documentation and reporting is consistent, organized, and available for readiness reviews. Other duties as assigned. Join our team as we strive for excellence through teamwork, where our patients are #1! IHCS is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

Responsibilities

Support compliance and quality initiatives by identifying and developing the ongoing needs of the department.
Provide input toward solution to department audits.
Develop and (Run/establish/monitor/ make recommendations of audits)
Ensure compliance and adherence to Federal and State regulations and contractual requirements as well as direct contribution to the prevention detection and elimination of fraud waste and abuse in the organization and in network.
Remain current on Health plan regulations and make certain rest of compliance group is aware of changes.
Escalates critical issues or potential concerns to Compliance Officer/DME Director and may be asked to represent in business meetings or similar settings.
Lead and execute end-to-end internal quality audits, risk assessments, and root cause analyses across clinical, operational, and administrative areas.
Develop audit plans, tools, and protocols in accordance with CMS, NCQA, URAC, HIPAA, and other regulatory or accreditation standards.
Monitor corrective action plans (CAPs) and track implementation through closure, providing coaching to departments when needed.
Prepare audit summary reports, dashboards, and executive-level presentations on audit findings and trends.
Serve as lead liaison during external audits, surveys, or mock audits, representing the organization with regulators, payers, and accreditation bodies.
Maintain and revise standard operating procedures (SOPs) and work instructions related to QA activities.
Collaborate with Quality Improvement, Compliance, Operations, and Medical Management teams to implement best practices.
Assist with training and mentoring of QA staff and audit interns.
Identify and recommend process improvements and automation opportunities.
Participate in quality committees and enterprise-level initiatives.
Ensure audit documentation and reporting is consistent, organized, and available for readiness reviews.
Other duties as assigned.