Utilization Management Quality Reporting and Auditing Specialist I

L.A. Care Health Plan•Los Angeles, CA

56d

About The Position

The Utilization Management (UM) Quality Reporting and Auditing Specialist I is responsible for dynamically working with the quality team and UM Leadership to support and ensure effective implementation of reporting and auditing work plans and projects on behalf of L.A. Care’s Utilization Management Quality Program by working collaboratively and independently on components of reporting and auditing projects as assigned.

Requirements

At least 2 years of experience in a healthcare quality or quality/compliance role.
Experience navigating a EMR/ system.
Experience in using analytical skills related to reporting and data processing.
Ability to work under pressure with multiple deadlines.
Excellent verbal and written communication skills.
Ability to develop reports and documents on an as-needed basis.
Strong Microsoft Excel knowledge and skills
Knowledge of location of federal and state requirements and standards especially related to reporting and auditing.

Responsibilities

Ensures successful completion of assigned quality projects related to reporting, auditing, preparation and execution of external and internal audits while working with UM department to support quality projects including improvement and auditing and monitoring functions.
Completes projects related to the UM departments Quality and Compliance/Regulatory/Accreditation projects and cross functional departments and teams.
Supports the UM department with routine reporting and auditing/quality activities and work plans especially related to quality, reporting, regulations, accreditation and compliance.
Manages administrative activities related to reporting, compliance, and quality projects in the UM department.
Plans and organizes collaboratively and cross departmental meetings to problem solve, document issues and validate activities or reports.
In collaboration with leadership and trainers, provides education to staff based on results of audit findings, including but not limited to assisting with updating job aids and demonstration of compliant processes in group or individual meetings.
Applies knowledge of federal and state requirements/standards to ensure compliance for reporting and auditing.
Performs other duties as assigned.