Clinical QI Auditor & Trainer , LVN/RN

Job Description

Position Summary :

The Quality Improvement A G Auditor / Trainer reports to the Manager of QI and carries out the day-to-day activities related to ensuring compliance to QI Standards and State and Federal Regulations by auditing staff work case files using standardized tools implemented by the QI Department Manager. The role of the QI A G Auditor / Trainer is to promote and support the quality and cost effectiveness of medical care through the monitoring and distribution of production and daily auditing for quality. The QI A G Auditor / Trainer will also maintain all QI Training modules and serve as an intra-team contact for staff for questions relating to their training needs. The QI A G Auditor / Trainer is a key member of the QI Department Team and works closely with the Manager of QI. The QI A G Auditor / Trainer adheres to NCQA, State and Federal and other Regulatory agency standards and turn-around times while carrying out the QI duties and responsibilities.

Essential Duties and Responsibilities include the following :

• Will be the department trainer for new and current employees.
• Operationalized the RMG / LMG and HPN policies and procedures to assist to create and maintains all job aid / training material.
• Performs staff case file audits using standardized tools and gives suggestions for improvement on processes as may be necessary.
• Understand, promote and audit the principles of QI to facilitate the accurate and timely Grievances Appeals.
• Understands all aspects of the functionality of Access Express, EZCAP, NextGen, DM Lite etc. with the respect to QI A G, prior authorization and the customer service case modules as well as the Administrative Assistance process.
• Carries out the direction or instructions for QI activities as given by the QI Manager.
• Timely Audit to ensure that the complete process is properly followed via monthly audits using the standard auditing process / reporting and to be able to identify trends timely. To be able to identify if additional training is required.
• Responsible for setting personal goals and timetables and coordinates activities to ensure smooth workflow and time management.
• Identifies and analyzes problems and takes steps to provide suggestions for solutions as appropriate.
• Acts in concert with other staff to problem-solve member issues and give feedback on Appeals and Grievance process and activities.
• Ability to make sound decisions and present and implement company policies, procedures and goals and ensure that the QI P P are followed.
• QI A G Auditor / Trainer / Trainer is a key member of the QI Department and Assists QI staff as needed in order to complete work timely and accurately.
• QI A G Auditor / Trainer / Trainer to produce timely charts, graphs, reports to demonstrate results and outcomes.
• Complete assigned tasks accurately and within specified time limits.
• Maintain health working relations with co-workers and manager.
• Prepares and maintains records and files which are neat, organized, thorough and readily accessed.
• Completes assignments within specified timelines.
• All written and verbal communication and transmission of information is professional, clear, concise and in proper business and grammatical format.
• Adheres to Confidentiality and HIPAA regulations.
• Filing, faxing, copying, purging of files.
• All other duties as assigned by management.

The pay range for this position at commencement of employment is expected to be between $37.50-40 / hour for LVN and $45-$50 / hour for RN ; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and / or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department / team performance, and market factors.

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

Full Time Position Benefits :

The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

Health and Wellness :

Savings and Retirement :

Other Benefits :

Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

Requirements

Education and / or Experience :

Salary : $38 - $40