Job added in hotlist
Applied job
Contract job
Recruiter job
Employer job
Expanded search
Apply online not available
View more jobs in San Diego, CA
View more jobs in California

Job Details

Clinical Practice Performance Consultant Auditor - California

San Diego, CA

Apply for this job

2 hit(s)  


The Registered Nurse CPC/FSR Nurse will work closely with the Director of Clinical Quality and other internal and external stakeholders to coordinate an interdisciplinary approach to increased provider performance and compliance to State standards regarding the Facility Site Review program. The person in this position is responsible for strategically developing clinically oriented provider and community based partnerships in order to: 1) increase quality scores based on California quality measures; and 2) to complete DHCS facility site, medical record and physical accessibility reviews. The person in this position is responsible for ongoing management of provider practice and community education on California quality measures. This role includes planning and devliering provider education regarding the Quality Improvement program including analysis and review of quality outcomes at the provider level; monitoring, measuring and reporting on key metrics to assist providers in meeting quality standards, state contractual requirements and pay for performance initiatives.
The Registered Nurse CPC/FSR Nurse will focus on tasks that occur in accordance with State (DHCS and DMHC), CMS, NCQA, and/or other requirements as applicable. The role assists contracted providers with preparing for Faciity Site Reviews, analyzing member care, trending quality compliance at the provider level, and developing action plans and programs to support provider practices in continuous quality improvement using approved DHCS auditing tools, clinical practice guidelines, HEDIS, CMS, NCQA and other resources. Position will be responsible for coordinating visits and administrative functions associated with the site reviews.
If you are located in San Diego or Sacramento, CA, you will have the flexibility to telecommute* as you take on some tough challenges. This position requires travel to physician offices in San Diego or Sacramento up to 75% of the time.
Primary Responsibilities:
Complete Facility Site, Medical Record Reviews, and Physical Accessibility Reviews
Education and Engagement of Practice-Level Leadership
Targeted Quality Improvement Activities
Medical Record Review to Identify HEDIS Care Gap Closures
Relationship Management - Internal and External
Community Engagement and Interaction
Provider and Practice Education, Quality Oriented Health Topics
Data Entry; Administrative Functions to Facilitate the Facility Site Review Process
Policy Review; Development of Standard Operating Procedures
Audit Preparation and Representation for Regulatory Audits
Required Qualifications:
Current unrestricted RN licensure required in the state of operation
5 years clinical experience, or other relevant experience
1 years of experience reviewing medical records within a regulatory audit capacity
DHCS Facility Site Reviewer Certification or ability to obtain within 12 months
Preferred Qualifications:
Knowledge of one or more of: clinical standards of care, preventive health standards, HEDIS, NCQA, governing, regulatory agency and facility requirements, and the managed care industry
2 years of quality improvement experience, or other relevant experience
Experience working in Medi-Cal and/or Medicare
Health care and insurance industry experience, including regulatory and compliance
Bachelors degree or higher in Science or related field
DHCS Master Trainer Certification
Experience communicating effectively with broad audience including Physicians, nurses, non-clinical office staff, and across the Health Plan
Strong organizational skills and ability to work both independently and with teams
Experience working in a collaborative environment with ability the to influence others and build strong professional relationships
Experience with making formal presentations within the context of their role
Experience using databases to input information and prepare reports as needed
Proficiency in software applications that include, but are not limited to, Microsoft Word, Microsoft Excel, Microsoft PowerPoint
Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)
*All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: CPC, Clinical Practice Consultant, Auditor, RN, Registered Nurse, HEDIS, Quality, DHCS, DMHC, CMS, NCQA, site reviewer, Medi-Cal, Medicare, San Diego, Sacramento, CA, California, Telecommute, Telecommuter, Telecommuting, Remote
apply now
Please mention
if asked how you found this job.

Company info

Sign Up Now -

Similar Jobs:
Senior Regulatory Affairs Specialist
Location : San Diego, CA
Summary: Dexcom Regulatory Affairs seeks individuals who have an eye for detail, strong writing and organizational skills, and the ability to adapt to change. The Senior Specialist is preferred to have a minimum of three years in...
Xencor an innovative biotechnology company located in the Los Angeles area (near Pasadena) and in San Diego.We have a very deep drug development pipeline including three programs currently in clinical testing with one more ...
Employee Type: Full-Time Location: San Diego, CA Job Type: Strategy - Planning Experience: Not Specified Date Posted: 6/14/2018 About Us At Booz Allen, we harness our collective ingenuity to solve our clients toughest m...
The number of jobs listed on EmploymentCrossing is great. I appreciate the efforts that are taken to ensure the accuracy and validity of all jobs.
Richard S - Baltimore, MD
  • All we do is research jobs.
  • Our team of researchers, programmers, and analysts find you jobs from over 1,000 career pages and other sources
  • Our members get more interviews and jobs than people who use "public job boards"
Shoot for the moon. Even if you miss it, you will land among the stars.
ComplianceCrossing - #1 Job Aggregation and Private Job-Opening Research Service — The Most Quality Jobs Anywhere
ComplianceCrossing is the first job consolidation service in the employment industry to seek to include every job that exists in the world.
Copyright © 2018 ComplianceCrossing - All rights reserved. 168