- LA Care Health Plan (Los Angeles, CA)
- Delegation Oversight Clinical Auditor RN II Job Category: Clinical Department: Audit Services Location: Los Angeles, CA, US, 90017 Position Type: Full ... to achieve that purpose. Job Summary The Delegation Oversight Clinical Auditor RN II is responsible for...for ensuring that delegates contracted to perform Utilization Management ( UM ) functions on behalf of LA Care (LAC) is… more
- Molina Healthcare (Dallas, TX)
- **KNOWLEDGE/SKILLS/ABILITIES** + Performs monthly auditing of registered nurse and other clinical functions in Utilization Management ( UM ), Case Management (CM), ... Management (HM), and/or Disease Management (DM). + Monitors key clinical staff for compliance with NCQA, CMS, State and...or related field. **Required Experience** + Minimum two years UM , CM, MAT, HM, DM, and/or managed care experience.… more
- Somatus (Mclean, VA)
- …+ Support quality improvement team in the development of reporting to prioritize clinical and service improvement initiatives and address identified barriers. + ... + Community engagement opportunities + And more! The Quality Auditor effectively and efficiently manages a diverse workload in...interventions, member experience, as well as the quality of service provided to Somatus by any vendors. The Quality… more
- InnovaCare (San Juan, PR)
- …to the Utilization Management Inpatient Coordinator.14. Prepares and submits to the Health Services Department / UM Medical Care Manager a monthly report of ... compliance with the Plan's SNP policies and MOC requirements. Clinical staff who do not complete the required annual...care, on site or telephonically to validate appropriateness of services , lengths of stay and levels of care, utilizing… more