Clinical Nurse Auditor RN Job Listing at MedStar Medical Group in Baltimore, MD (Job ID req48307)

Description

General Summary of Position
The Nurse Auditor, Clinical Operations MFC DC and MD will coordinate all activities associated with clinical activities, including the development and review of training, and auditing materials, performing auditing of clinical team members including but not limited to Case Management (CM) and Utilization Management (UM), and preparation for the actual and mock NCQA audits. The Nurse Auditor will perform audits to evaluate individuals' compliance with clinical processes, National Committee for Quality Assurance (NCQA) standards, regulatory requirements, and of overall clinical program effectiveness and efficiency. The Clinical Nurse Auditor will report to and work closely with the Assistant Vice President (AVP), Clinical Operations to monitor, maintain, and support the clinical department to maintain a high level of quality performance and comply with regulatory requirements and accreditation standards. The Clinical Nurse Auditor participates on departmental and organizational project teams and plays a critical role in project implementation by soliciting requirements through interviews, workshops, and/or existing systems documentation or procedures and ensuring that all impacted processes and systems are evaluated. The Clinical Nurse Auditor works closely with the Clinical Department in assisting with the definition, documentation, training, and support for new required accreditation processes. As a member of the Clinical Operations team the Clinical Nurse Auditor will have an opportunity to support improved accessibility to key business information, ensure process integrity, and develop process flexibility which contributes to the success of the organization. The auditor will maintain current knowledge about NCQA, contract requirements, healthcare / industry trends, District regulations, and other compliance standards.

Primary Duties and Responsibilities

Minimum Qualifications
Education

• Bachelor's degree Nursing required

Experience

• 1-2 years Case Management and utilization review experience required and
• 1-2 years Auditing required and
• 3-4 years Diverse clinical experience required

Licenses and Certifications

• RN - Registered Nurse - State Licensure and/or Compact State Licensure Valid RN license in the District of Columbia and Maryland Upon Hire required

Knowledge, Skills, and Abilities

• Skilled in planning, executing, and evaluating audit gaps and developing performance improvement initiatives
• Possess exceptional interpersonal and communication skills
• Knowledge of current trends in healthcare delivery and Case Management / utilization review criteria
• Ability to use computer to enter and retrieve data.
• Ability to create, edit and analyze (Word, Excel and PowerPoint) preferred

This position has a hiring range of $87,318 - $157,289